School Based Services Medicaid Provider Liaison Meeting

1

School Based ServicesMedicaid Provider Liaison Meeting

Michigan Department of Community HealthFebruary 25, 2010

2

Agenda

• Introduction• School Based Services Administrative Outreach Program

– Program Status– Back-casting Settlement and Recovery Finalized

• School Based Services Direct Medical Services– Program Status– First Year Issues

• Significant Events of 2009 (Direct Medical Services)– New Reimbursement Methodology Effective July 1, 2008– Personal Care Services Coverage Added– New SBS Specialized Contacts

3

Agenda (cont.)

• What’s New for 2010 (Direct Medical Services) – New Medicaid Allowable Expenditure Report (MAER) Software Improvements– New Summer Time Study Quarter Start Date (the date the students return to

school)– New Training on Cost Report Adjustment Process– Reconciliations and Initial Settlements Begin March 2010

• Timeline slide– On-site Audits Begin March 2010 – On-line Staff Pool List Updates

• Demonstration by Public Consulting Group

• CHAMPS Update• Contact Information• School Based Services Provider Specific Web Page• Questions and Answers

4

School Based Services Administrative

Outreach Program (AOP)

• Program Status– RMTS results holding constant

• Back-casting Settlement and Recovery Finalized

5

School Based ServicesDirect Medical Services

• Program Status• First Year Issues

– Effective July 1, 2008 – New Reimbursement Methodology• Two part process

– Cost reports– Procedure specific billing through Community Health Automated Medicaid Processing

System (CHAMPS)– Medicaid Allowable Expenditure Report (MAER) Issues

• Downloading and saving the MAER (cost report)• Transportation MAER

– Staff pools issues– CHAMPS issues

6

Significant Events of 2009 (Direct Medical Services)

• New Reimbursement Methodology Effective July 1, 2008– Cost Reporting

• Personal Care Services Coverage Added• New SBS Specialized Staff

– Provider Support SBS Contact – Lynn Hicks– SBS Provider Training Specialist – Lisa Trumbell– SBS Internal Auditor – Matt Hiatt– SBS Cost Settlement Auditor – Vaughn Allen

• Cost Reconciliation Update

7

What’s New For 2010(Direct Medical Services)

• New MAER Software Improvements– MAER modifications to utilize buttons instead of menu selection– Per CMS mandate object codes 4120 and 4220 will be removed from the cost

reports• New Summer Time Study Quarter Start Date

– Supported by the schools to improve RMTS accuracy and results– Date students return to school– How this impacts time study results

• On-site Audits Begin March 2010– The purpose of the internal audit function is to work as a partner with the ISDs

and LEAs to assure system and internal controls are in place– L Letter 09-23 outlines the process (copies available)

• Reconciliation and Initial Settlements Begin March 2010– Reconciliations and settlements processed in the order they are received

• New Training on Cost Report Adjustments Process– WebEx training beginning in April, 2010

• On-line Staff Pool List Updates– Demonstration by Public Consulting Group

8

Timeline

October MAER Template available for download on MDCH website

November LEAs and ISDs complete MAER

November 30th MAER due to ISD

Summary Software Application available for download from MDCH website

December ISDs compile summary reports

December 31st Summary reports due to MDCH (Extended to January 31st for first year only)

January Initial ISD settlements begin (March for first year only)

Spring Revisions to MAER and Summary Reports, as necessary

July Final ISD Settlements may begin

Oct Nov Dec Jan Feb March April May JuneTimeline for School Year

Reconciliation and Settlement

9

CHAMPS Update• CHAMPS Implementation September 18, 2009• Changes and Issues

– New data format – Claims rejecting– Change from scope and coverage to “Benefit Plan”– Now able to check eligibility in CHAMPS

• New claims processing & adjudication system• Replaced old Invoice Processing System

– Old MMIS system was over 30 years old• Provider Able to See Claim Status• Direct Data Entry• On-line Claim Adjustments/Voids• Outstanding CHAMPS Issues

– Prior Authorization (affects only V2799) – est. fix date Feb. 2010– Diagnosis Code (affects all codes, CHAMPS error code 1307) – est. fix date Feb.

2010– T1024 still rejecting

10

Policy and Audit Contacts

• Direct Medical School Based Services (Fee-for-service)– Linda Sowle

[email protected]

• Administrative Outreach Program (AOP)– Penny Dipple

[email protected] 517-241-5159

• Cost Reporting and Cost Settlement– Vaughn Allen

[email protected]

• Internal Audit– Matthew Hiatt

[email protected]

11

Provider Relations Contacts

Contacts Billing issues:

Provider Inquiry:[email protected]

Provider Consultants:Conduct research of complex claim [email protected]

Provider Outreach:Offer educational seminars regarding billing and [email protected]

12

Provider Relations Contacts

Provider EnrollmentFor questions regarding enrolled providers.Telephone: (517) [email protected]

CHAMPS Helpline: For issues regarding navigating the CHAMPS on-line enrollment system. [email protected]

13

School Based Services Provider Specific Webpage

• The Michigan Department of Community Health maintains a webpage of SBS specific documents

• This webpage houses:– Compliance reports– Time study reports– MAER download– Training documents for the MAER, Staff Pool Lists, State Single Sign On and File

Transfer

• To access this webpage go to:– http://www.michigan.gov/medicaidproviders , click on “Billing and

Reimbursement”, click on “Provider Specific Information”, click on “School Based Services” (see screen prints on the following pages)

14

15

Click here

16

Click here

17

Click here

18

19

Conclusion

Questions & Answers