Embed Size (px)
DESCRIPTION
PAIU Workgroup Meeting School-Based ACCESS Program. February 7, 2013. www.pcgeducation.com. Agenda. Accomplishments SBAP Update Service Logs Billing volumes Exception Report Update Claiming Update RMTS Update MCRCS Update Medicaid Eligibility Next Steps – Action items. - PowerPoint PPT Presentation
Citation preview
PAIU Workgroup MeetingSchool-Based ACCESS ProgramFebruary 7, 2013
www.pcgeducation.com
Agenda
2
Accomplishments
SBAP Updateo Service Logs
o Billing volumes
o Exception Report Update
o Claiming Update
RMTS Update
MCRCS Update
Medicaid Eligibility
Next Steps – Action items
SBAP Service Log Activity (through 2/5/2013)
3
• Jan 30 DATA UPDATE:• 488 LEAs have submitted
• 1,434,075 service logs
• Feb 6 DATA UPDATE:• 491 LEAs have submitted
• 1,571,233 service logs
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Mid Sept End Oct End Nov Mid Jan End Jan 1st Wk Feb
0180,000
487,300615,300
1,335,0001,435,000
65,000
155,000
128,000
720,000
100,000
136,000Services
PA SBAP – Billing History (July, Aug, Sept)*
4
Service Logs ProcessedDecember cycle January cycle
Service Logs Processed
All Logs 89,576 354,876
Billable Logs 81,442 308,771
Total logs billed 24,968 37,474
Total Service Units 98,215 175,743
Total Charged $1,068,140 $1,812,108
Services Not Billed 56,474 271,297
* Only months of July, Aug, Sept were processed, awaiting 2013 rates to be approved to process logs Oct 1 or later
Claiming Update• The FY13 district-specific billing rates have been established
and approved by DPW
• Claims will be generated and submitted by 2/14/13 for all services, all districts for the months of October – December 2012
• Claims will also be submitted for July – September, 2012 by 2/15/13
• Next claim run will be during the week of February 28, 2013
5
PA SBAP – Exception Report Detail
6
Exception Reports Students Services Students ServicesMissing Access Coordinator Approval 8836 68508 *2471 88255Missing IEP Dates 5301 37619 5339 35638Missing PA Secure ID 560 4135 161 2041Missing Parental Consent 3002 26415 4508 42868Missing Physician Authorization 10968 84743 17632 119934Missing Provider Certification 3276 94027 2680 84960
December 19, 2012 J anuary 16, 2013
* changed from students to providers at LEAs request
Exception Report Process• Part of PCG standard process for school-based billing programs is to
conduct automated compliance/edit checks on all data prior to claim submission to DPW
• Services that do not pass all checks are not claimed for, reports are generated illustrating why services did not pass
• Reports are then distributed to LEAs
• Initial exception reports were distributed first week of January, 2013o Response has been strongo 2nd claiming cycle showed vast improvements
• This process ensures that districts have the documentation and data necessary to file compliant claims, reducing and eliminating audit risk
7
Random Moment Time Study (RMTS)• Q1 results (Oct – Dec, 2012)
• Total moments 6,000 (both cost pools)• Total responses: 4,943• Response rate: 82.38%
• Roster update for Q2 (Jan – March, 2013)• Roster updates for Q2 completed December 7, 2012
• 578 LEAs have rosters in RMTS• 54 LEAs do not have rosters in RMTS -- No EI programs
• Roster update for Q3 (Apr – June, 2013)• Four week email, live webex campaign begins Feb 1• Weekly emails, weekly Q&A live webex’s• Roster updates must be completed by March 8, 2013
8
RMTS Discussion Items• RMTS Calendars are obtained from each entity for the entire year
• Calendar is updated with unscheduled days off (snow days, emergencies, etc.)• Calendars are all entered into the system, an algorithm is run on the calendars
and the most consistent/common days/times result in a uniform/average PA calendar
• No moments are distributed on days off based on this average calendar
• RMTS Participants are all trained to answer system questions clearly and in a straightforward manner
• Lunch time is an appropriate answer• Time off is an acceptable answer• Travel time between schools is an acceptable answer
9
Medicaid Cost Reporting & Claiming System (MCRCS)
• Web-based tool for capturing allowable, actual costs from LEAs• Training dates have been announced via email & SBAP website
o 1/31, 2/1, 2/4, 2/5, 2/6, and 2/8o Dates & times posted on Training Calendar for registrationo ACCESS Coordinators & Business Managers are registering
• MCRCS deadline for cost data entry is March 8, 2013
• MCRCS is the web-based system created by PCG for school-based Medicaid programs. The purpose of the system is to:o Capture all allowable, reimbursable costs for both quarterly administrative
claiming and annual cost reportingo If costs aren’t entered MAC claims and the cost report cannot be completed,
impacting ACCESS reimbursement for districts
10
Medicaid Matching• PCG conducts a monthly Medicaid match on all students in EasyTrac
o Match consists of ‘exact’ matches on name, DOB, and gender and secondary matches using parts of the first name, parts of the last name, DOB and gender
o For secondary, or enhanced, matches PCG staff evaluate the detailed records from both files to determine if a match truly exists
o If last name from the district records is completely different than last name from DPW records, match is not accepted
• Significant audit risk exists if names between the two files don’t match or closely resemble one anothero Worst case scenario with an auditor is to have a Medicaid ID assigned to wrong
student and claims are being submittedo Nicknames, shortened names, hyphens, apostrophes, middle initials, etc are all
causes for matches to failo Process is for district to engage parent and have misspelling or name changes
updated in DPW or district files, whichever is incorrect
11
PCG Representative Assignments
12
Name & Email IU’s (and their districts)Patrick [email protected]
5, 6, 7, 8, 9, 10, 16, 28
1, 2, 3, 4, 17, 19, 27
Andy [email protected]
24, 25, EIwyn
Shawn [email protected]
18, 20, 22, 23
Jennifer [email protected]
13, 14, 21
Brittany St. [email protected]
26
Miguel [email protected]
11, 12, 15, 29
13
