Taos School District May Need To Pay State for Bad Medicaid Claims

January 19, 2010

The T aos Municipal Schools District could be required to reimburse the state for joint federal and state Medicaid payments for students needing disability assistance, a New Mexico Human Services Department spokesperson says.

The department found that the district inappropriately billed claims last year, HSD spokesperson Betina Gonzales McCracken said.

The payments were made under the Medicaid School-Based Services program, which compensates the district for health services to students with disabilities so they "can have the same opportunities as other children," McCracken said. "It pays for direct health services such as physical, speech and occupational therapy in a school setting. Then the schools can use those dollars to help those children."

The more severe the student’s problem, the more funding the district receives. McCracken characterized the district’s deficiencies as "inappropriate billing" and said Human Services considers it a serious issue "and we want to see it corrected."

School board member Stella Gallegos said the problem just came to her attention recently. "The board is always the last one to find out," Gallegos said.

In an April letter to Taos’s then-superintendent Alfred Cordova, the Medical Assistance Division listed these findings:

Ten claims billed outside IEP (Individual Education Plan) dates or current plan not available.

24 claims without the time or duration of service provided.

11 claims without progress notes.

No claims had procedure codes on billing documentation and some were missing a diagnosis code.

17 claims did not list the (health) prov ider ‘s credentials.

<p& gt;7 claims have no PCP (primary care practitioner) signature.

12 claims were without location, date and time of the service documentation.

For one quarter, expenditures were incorrect.

Payroll/salary benefit amounts on the claims did not match the amounts listed in school reports.

McCracken said HSD will soon be visiting the district to monitor efforts to correct the mistake.

"We’re ready," said Taos schools Medicaid facilitator Rayne Medina, who does all the Medicaid billing for schools in the district. "Everything is fixed."

She described the inaccuracies as "very minimal" and said she’s happy with procedural changes the district has made.

"Nobody was ever trained in this (the billing) – I trained myself," she said. Part of the problem was that previously a third party had done the Medicaid billing but now the district does it, she added. "We did have some things that were not done correctly."

Medina said that under the program the Taos district generally is reimbursed from $100,000 to $150,000 annually. According to McCracken, from July through October 2009 the MSBS program helped 8,391 children with disabilities statewide with total payments of almost $1.3 million

The findings may financially affect the school district because it may have to reimburse Medicaid for claims that were billed inappropriately. But so far, the findings have not resulted in the termination of the services contract between the Human Services Department and the district, McCracken said in an e-mail.