Medicaid Manwelcomes you…

Medicaid Fee for Service

Program2008-09

Medicaid Support

Regina Smith, Program Supervisor(O) 313.873.4085

Tanisha Vogl, Financial Specialist(O) 313.873.4283

We’re here to help you!

Fee-For-Service Recovery Effort

Seeks reimbursement for medically-related services provided to Medicaid eligible students pursuant to their IEP or IFSP.

Eligibility• Students must be:

• Special Ed

• Services must pertain to a “medical” service on the student’s IEP.

Medical Service?The service must involve one of the following areas:

• Speech / Audiology / Assistive Technology

• Psychology

• Social Work

• OT or PT

• Nursing

• Vision / Orientation &Mobility

• Personal Care

Unbillable - Record Keeping Only Services

• Use the Unbillable service option on your procedure code drop-down list if you want to track:– Missed sessions, consultations, services for

LD/CI only students, etc. that are not “billable”

These “services” will not generate claims, but should be made “ready to bill” to keep them off the “open services” report.

LD or CI OnlyIs the student Learning Disabled or Cognitively impaired ONLY? (No speech, social work, OT, PT, psychology, nursing, O&M, etc. on the IEP) Ancillary staff may still record MET and

IEP/IFSP Assessments

Case Management does not apply

The only reimbursable direct service is Crisis Intervention

The Unbillable code may be used for LD/CI services.

MET and IEPCase Managers Only

• Coordination of and participation in a MET or

IEP/IFSP may be recorded by the “Designated Case

Manager” only if the student’s IEP includes a

scheduled “Medically-Related” service.

• Use the Unbillable code for initial MET’s and IEP’s

• Use the Unbillable code for students without a

medical service

Recording Services

Information to be completed by the Practitioner:

Student’s “Presenting Problem”

TCM Service Code

Monthly Progress Note/Summary

Designated Case Management• Only ONE Designated Case Manager per student

• Recorded ONCE per month

• Service Date is the last school day of the month

• Use Procedure Code T2023

• Record the letter, A-K, that describes a single service during the month

• Provide service details in the Summary Note

Use the 3 W’s!

WHO?

• Were you interacting with:– Parent(s) or Guardian– Speech Path, Social Worker, OT, PT, etc.– Outside Agency

If only with the student – it’s a direct service – DO NOT BILL. Case management is for indirect services only.

WHAT?

• Be specific:

Good = Met with parents and social worker to discuss progress on behavioral goals

Bad = Parent Meeting

Use the 3 W’s!

Use the 3 W’s!

WHEN?

• Don’t forget to record actual Service Dates in your summary!!!

UNBILLABLE Case Management Services

• Direct services such as teaching, therapy and evaluations

• Services related to issues that are not addressed in the IEP or are not medically-related

• Academic, vocational, work skills services

• Initial MET and IEP

• Services rendered by other staff

DCM SummariesThe Good…

1/16/08 Met with RN to discuss change in medications

3/31/08 Contacted parents to discuss …therapy, counseling, meds, speech goals, BIP…

10/17/08 Conference with parents/service providers regarding…medical issues/ goals (describe)

DCM Summaries The Bad…

4/4/08 - Behavior

Testing/Woodcock Johnson

Report Cards

DCM Summaries The UGLY…

Math, Reading, Language, Work Skills

No Services this month

FYI: Personal Care ServicesAre Now Billable

• When performed by an Aide for students whose disability prevents them from doing tasks on their own.– Meal Preparation, Feeding, Toileting, Personal

Hygiene, Mobility/Positioning, Skin Care, etc.

– A Service “log” is required for each student

– District staff enters data into Service Tracker

– RESA uploads data into Service Tracker for billing

This new service may affect your classroom

The False Claims ActPreventing Fraud, Waste, Abuse

Detroit Public Schools is committed to ensuring that its coding, billing and reimbursement procedures comply with all federal and state laws. However, we cannot ensure that the services reported were provided as stated, that they were medically necessary or were not false or misleading.

If you have knowledge or information that School-Based Services being reported to Detroit Public Schools Risk Management Office for the purposes of Medicaid billing are false or fraudulent, such as the falsification of records or submitting services for billing that were not performed, please report the situation to your supervisor or to the Attorney General’s Health Care Fraud Division at: 800-242-2873.

The False Claims ActPreventing Fraud, Waste, Abuse

Whistleblower Provision

Federal and state law prohibit any retaliation or retribution against any person who reports suspected fraudulent billing to law enforcement officials or who file “whistleblower” lawsuits on behalf of the government.

Random Moment Time Study (RMTS)

Your name has been put in a “pool” with all of the other Designated Case Managers in the state.

What is the RMTS?

Out of this pool comes the Random Moment Time Study. This is the tool that Michigan uses to determine the amount of time school staff spend on activities that are in support of the Medicaid program

When is the RMTS?

Every quarter, names will be drawn and you could be chosen at any point to participate in one or more of these random moment time study surveys.

There is no limit to how many times your name can be drawn in a quarter.

How Does It Work?

If you are selected to participate, you will receive notification in the mail that you need to complete a RMTS survey on-line. This should take no more than 10 minutes of your time. It is mandatory to complete your moment within 24 hours of the date/time of selected moment.

What Do I Have To Do?

In the Random Moment Time Study, a “moment” is one minute of time. Completion of the time study moment will require you to answer four questions regarding the activity you were performing during that one moment of work time.

4 Questions

• What were you doing?

• Who were you doing it with?

• Why were you doing it?

• Is the service documented in the IEP?

(Not exactly worded like this, but you get the idea)

Please Be Descriptive• Not descriptive:

Getting ready for my day

Catching up on Paperwork

Teaching

• Better:– Reviewing student behavior plan/IEP goals with parent

– Updating goals and objectives for next IEP

– Coordinating/Participating in the IEPT meeting/review

– Meeting with principal regarding accommodations for a visually impaired student

– Working with a student on …

No “Bad” Answers•It’s OK to say:

–I was on my lunch break–I was on a personal phone call–I was not at work (driving home), etc.

Only Public Consulting Group (PCG) sees your answers… RESA and your district cannot.

RMTS Follow-Up• If you are not descriptive enough and clarity is

needed, you will receive a follow-up call from Public Consulting Group.

• Please return follow-up phone calls promptly.

What If I Have Questions?

Contact the DPS Medicaid Office.

Questions and Answers