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					                   Department of Medical Assistance Services


Medicaid Reimbursement for
Special Education Services
   Medicaid Reimbursement for
   Special Education Services
                   Chandra Shrestha
                         Department of Medical Assistance Services
                                            Chandra Shrestha
                                      Anne Morrow
                                   Dept. of Medical Assistance Services
                                   PHBV Partners LLP
                                              Anne Morrow
                                            PHBV Partners LLP




 www.vita.virginia.gov
 www.dmas.virginia.gov                                                1 1
                  Department of Medical Assistance Services


Agenda
•   Overview/Status
•   Reimbursable Personnel Costs
•   RMTS
•   Medicaid Eligibility Percentages
•   BAAs
•   Tracking IEP students and the services in
    their IEPs




www.vita.virginia.gov
www.dmas.virginia.gov                                         2 2
                  Department of Medical Assistance Services


Agenda (cont)
•   Medical Services Cost Report
•   FFP Rates
•   Cost Report Schedule
•   Interim Billing of Claims
•   Self Audit Process
•   Transportation Cost Report




www.vita.virginia.gov
www.dmas.virginia.gov                                         3 3
                  Department of Medical Assistance Services


Medicaid “Experts”




     “While I can explain the meaning of life, I don’t dare
       try to explain how the Medicaid system works”

www.vita.virginia.gov
www.dmas.virginia.gov                                         4 4
                  Department of Medical Assistance Services

Summary of Reimbursement Changes (Since 2003)

• DMAS implemented admin claiming in 2003
• The Federal Government required DMAS to
  implement cost-based Reimbursement for
  medical services effective with the 2006-
  2007 school year. We are starting the sixth
  year.
• State Plan Amendments approved by CMS
  July 1, 2007 cover new services effective
  July 1, 2003 (audiology, personal care,
  medical evaluation, psych services
  furnished by social workers) and July 1,
  2006 (transportation)

www.vita.virginia.gov
www.dmas.virginia.gov                                         5 5
                  Department of Medical Assistance Services


Cost Based Reimbursement
• Began with FY07
• Claims must still be filed as evidence that
  services were provided, per CMS, the
  federal agency with Medicaid oversight
• Interim payments are made based on
  claims filed
• Cost reports are filed annually
• School divisions must refund interim
  payments if they do not file a cost report

www.vita.virginia.gov
www.dmas.virginia.gov                                         6 6
                  Department of Medical Assistance Services


Reimbursable Personnel Costs
• Reimbursable personnel costs of
  employees providing medical or
  administrative services =
• Personnel costs of providing medical
  and/or administrative services
• Times percentage of time spent on
  medical and/or administrative services
• Times Medicaid eligibility percentage



www.vita.virginia.gov
www.dmas.virginia.gov                                         7 7
                  Department of Medical Assistance Services


Reimbursable Personnel Costs Example

• Personnel cost = $100,000
  % of time spent = 50%
  Eligibility % = 10%
  Reimbursable personnel cost = 100,000 x
  0.50 x 0.10 = $5,000




www.vita.virginia.gov
www.dmas.virginia.gov                                         8 8
                  Department of Medical Assistance Services


Random Moment Time Study (RMTS)
• DMAS has used RMTS since FY09
• Time study administered by UMMS
• 2,401 sampled moments in each pool
• 20% oversampling results in 2,882
  moments per pool
• See the Administrative Services Schedule
  and Flowchart in the DMAS website for
  important dates


www.vita.virginia.gov
www.dmas.virginia.gov                                         9 9
                  Department of Medical Assistance Services


Medicaid Coordinators - RMTS
• Should ensure high response rates
• Should download incomplete moments
  from UMMS
  (https://www.chcf.net/chcfweb/?userID=)
  and provide reminders to participants
• Should keep UMMS updated on
  additions to and/or deletions from the
  list of participants

www.vita.virginia.gov
www.dmas.virginia.gov                                         10 10
                  Department of Medical Assistance Services


Validation - RMTS
• CMS requires 85% participation rate
  by all school divisions
• DMAS must review 10% of all
  manually adjudicated moments
• DMAS sends reminders to school
  divisions not achieving 85%
  participation rate each quarter
• DMAS cannot provide real time
  monitoring of all school divisions
www.vita.virginia.gov
www.dmas.virginia.gov                                         11 11
                  Department of Medical Assistance Services


Medicaid Eligibility Percentage (MEP)
• Refers to Medicaid, Medicaid
  Expansion, and FAMIS eligibility
  percentage
• MEP for Admin Claiming = Total
  number of division-wide Medicaid
  and Medicaid Expansion eligible
  students / Total number of students
  enrolled division-wide

www.vita.virginia.gov
www.dmas.virginia.gov                                         12 12
                  Department of Medical Assistance Services


Medicaid Eligibility Percentage                     (cont)

• MEP for Medical Claiming is calculated as
  follows
• Number of Medicaid (Expansion/FAMIS)
  eligible students with an IEP / Total
  number of students with an IEP/POC as of
  Dec. 1 with or without parental consent
• Beginning in FY11, school divisions do not
  exclude students without parental consent
• They will be accounted for in the audit

www.vita.virginia.gov
www.dmas.virginia.gov                                         13 13
                  Department of Medical Assistance Services


Medicaid Eligibility Percentage - Example
• Number of Medicaid eligible students
  with an IEP/POC = 400
• Number of Medicaid Expansion eligible
  students with an IEP/POC = 200
• Number of FAMIS eligible students with
  an IEP/POC = 200
• Number of IEP students with parental
  consent = 100

www.vita.virginia.gov
www.dmas.virginia.gov                                         14 14
                  Department of Medical Assistance Services


Medicaid Eligibility Percentage – Example (Cont)

• Total Number of students with an
  IEP/POC = 2,000
• MEP for Medical Claiming
  = (400+200+200)/2,000 = 0.4
  = 40%




www.vita.virginia.gov
www.dmas.virginia.gov                                         15 15
                    Department of Medical Assistance Services


Access to Protected Health Information (PHI)
  • DMAS can't identify a school
    division’s IEP students (FERPA)
  • School divisions can't identify their
    Medicaid students without assistance
    from DMAS (HIPAA)
  • Access to data containing PHI is
    allowed after the school division
    signs a Business Associate
    Agreement (BAA)
  www.vita.virginia.gov
  www.dmas.virginia.gov                                         16 16
                  Department of Medical Assistance Services


Access to Medicaid Eligibility Data
• Upon signing the BAA, the school
  division can access eligibility data files
  and can search for matches between
  the IEP student population and
  Medicaid, Medicaid Expansion, and
  FAMIS population
• No school division should attempt to
  access Medicaid eligibility data before
  submitting a signed BAA to DMAS
www.vita.virginia.gov
www.dmas.virginia.gov                                         17 17
                  Department of Medical Assistance Services

Access to Medicaid Eligibility Data
                                (Cont)
• The File Transfer Protocol (FTP) –
  Provides a list of school age Medicaid
  members in the SD’s locality or
  neighboring localities
• One file contains the data from all
  localities that a school division requests
• If a school division needs data from
  more or fewer localities, it should
  contact Chandra Shrestha at DMAS

www.vita.virginia.gov
www.dmas.virginia.gov                                         18 18
                  Department of Medical Assistance Services


Medicaid Eligibility Reports
• The Medicaid eligibility reports are produced
  once per quarter on Sep. 1, September 1,
  December 1, March 1, and June 1
• They are used to calculate eligibility
  percentages
• If the reports are not retrieved by the
  following quarter, the information is deleted
  from the site
• The data is real-time eligibility data which
  cannot be regenerated
www.vita.virginia.gov
www.dmas.virginia.gov                                         19 19
                  Department of Medical Assistance Services


Medicaid Eligibility Reports (Cont.)
• The data can be retrieved only once from the FTP
  site by the designated school division person -
  multiple staff cannot retrieve the data, so save
  the quarterly data
• Password protect it so it will be secure
• Save it EVERY quarter with that quarter in the file
  name so it can be easily identified
• Instructions for retrieving eligibility data are at
  the DMAS site:
  http://dmasva.dmas.virginia.gov/content_atchs/r
  si/ab-em1.pdf
www.vita.virginia.gov
www.dmas.virginia.gov                                         20 20
                    Department of Medical Assistance Services


Service Center Agreement with Xerox – Fiscal Agent
  • Xerox (formerly ACS) provides FTP download of
    eligibility data
  • Go to https://vammis-filetransfer.com to access
    eligibility data
  • Call Xerox Helpline, 1-866-352-0496, for
    password and data resets or system issues
  • For instructions to use FTP refer to:
    http://www.VirginiaMedicaid.dmas.virginia.gov
      – Quick Links: Provider Services
                     Provider Manuals
                     Service Center User Manual
  • Follow instructions to download eligibility data

  www.vita.virginia.gov
  www.dmas.virginia.gov                                         21 21
                  Department of Medical Assistance Services


Enlisting New Medicaid Coordinator with Xerox

• Send a letter on SD letterhead to Xerox
• State the new Medicaid Coordinator’s
  name, phone number, and e-mail
  address
• State the name and title of the person
  who is being replaced
• Have the letter signed by an authorized
  party at the SD

www.vita.virginia.gov
www.dmas.virginia.gov                                         22 22
                  Department of Medical Assistance Services


Obtaining Help from Xerox
• Ensure the SD has submitted a signed
  BAA to DMAS
• Ensure the contacting person from the SD
  is enlisted with Xerox
• Know the SD’s four digit code, which is
  also called the Service Center Code or
  Region Code
• The code starts with the letter S and is
  followed by three numbers

www.vita.virginia.gov
www.dmas.virginia.gov                                         23 23
                  Department of Medical Assistance Services


BAA and FTP Contacts
• For BAA and FTP help from DMAS:
  Pat Lawver
  804-225-4042
  pat.lawver@dmas.virginia.gov
• For system issues, FTP, and
  password reset help from Xerox:
  Xerox Helpline: 1-866-352-0496

www.vita.virginia.gov
www.dmas.virginia.gov                                         24 24
                  Department of Medical Assistance Services


Documents or Spreadsheets Containing PHI
• If you have Personal Health Information
  (PHI) to transmit to DMAS or PHBV
  Partners, please fax the data or call any
  of your contacts for instructions on
  sending PHI
• You will be given a one time password
  and instructions for sending protected
  data
• Never send PHI data unsecured
www.vita.virginia.gov
www.dmas.virginia.gov                                         25 25
                  Department of Medical Assistance Services


Claiming for Services Delivered
• School divisions must submit claims for
  services delivered to IEP Medicaid
  students to get reimbursed
• Track the services delivered out of the
  services prescribed
• Track the services paid out of the
  delivered services that were billed
• Claiming percentage = Number of services
  paid/Number of services delivered

www.vita.virginia.gov
www.dmas.virginia.gov                                         26 26
                  Department of Medical Assistance Services


Claiming Percentage for Self Audit – An Example

• Randomly selected Medicaid students
  with IEP and medical services = 50
• Prescribed services from the IEP (60
  services per student) = 3,000
• Services actually delivered (50 services
  per student) = 2,500
• Services actually paid (40 services paid
  per student) = 2,000

www.vita.virginia.gov
www.dmas.virginia.gov                                         27 27
                  Department of Medical Assistance Services

Claiming Percentage for Self Audit – An Example
                                 (Cont)

• 500 prescribed services not delivered
• 500 delivered services not paid
• Claiming Percentage
  = Number of services paid/Number
  of services delivered = 2,000/2,500
  = 0.8 = 80%


www.vita.virginia.gov
www.dmas.virginia.gov                                         28 28
                   Department of Medical Assistance Services


Reasons for Not Delivering all Prescribed Services

 • Student sick or absent for any
   reason
 • Field trip or alternate activity
 • Testing day
 • School cancelled for weather,
   earthquake, or some other reason



 www.vita.virginia.gov
 www.dmas.virginia.gov                                         29 29
                  Department of Medical Assistance Services

 Reasons for Not Getting Paid for all Delivered
                    Services
• Didn’t have parental consent for some or
  all services delivered to a student
• Practitioner did not complete
  documentation
• Paperwork lost (the dog ate it!)
• Claims not submitted
• Claims denied, not corrected



www.vita.virginia.gov
www.dmas.virginia.gov                                         30 30
                  Department of Medical Assistance Services


Keys to Reimbursement
• Track Medicaid IEP students, the services
  prescribed, and the services delivered
• Make sure parental consent is obtained to
  bill from day one
• Ensure billing is performed for all services
  delivered and rejected claims are
  resubmitted, if appropriate



www.vita.virginia.gov
www.dmas.virginia.gov                                         31 31
                  Department of Medical Assistance Services


Tracking IEP students
• Tracking IEP Medicaid students is a crucial part of
  the billing and cost reporting process required by
  CMS
• A form - IEP Caseload Tracking Tool - is available
  on the DMAS Cost Reporting website:
  http://dmasva.dmas.virginia.gov/content_pgs/pr-
  sbs.aspx
• If you use this form at the beginning of the school
  year, you will have everything you need for the Self
  Audit


www.vita.virginia.gov
www.dmas.virginia.gov                                         32 32
                  Department of Medical Assistance Services


Tracking IEP students
• Identify the Medicaid IEP students and the services
  prescribed
• Parental consent is required for billing for services
  delivered
• The billing process begins after parental consents
  are signed
• Consider adding parental consent to the IEP
  conference
• Track Medicaid IEP students, the services
  prescribed, services provided and services paid
• There are no shortcuts to this process!
www.vita.virginia.gov
www.dmas.virginia.gov                                         33 33
                  Department of Medical Assistance Services


Direct Services (Medical) Cost Report
Costs that would be eligible for payment, if
 the child were Medicaid eligible:
 1. Direct costs beginning with salaries of
     practitioners whose services could be
     billed
 2. Times the percentage of time a typical
     practitioner is performing billable
     services (as determined by RMTS)
 3. Times the percentage of Medicaid
     eligible students in the IEP pool
www.vita.virginia.gov
www.dmas.virginia.gov                                         34 34
                  Department of Medical Assistance Services


Cost Reporting Groups
• Essentially the same cost report as
  the past year – only two medical
  professional categories
• Psychologists, psychiatrists, social
  workers, personal care assistants,
  nurses, physicians, and billing staff
• The therapists - physical,
  occupational, speech; and
  audiologists
www.vita.virginia.gov
www.dmas.virginia.gov                                         35 35
                  Department of Medical Assistance Services


Contractor Costs
• New pages added to accommodate
  change re Contractor costs
• New Section 3E – 3H used to report
  Contractor costs
• Contractors that perform Medicaid
  eligible medical services will no
  longer be included in the Random
  Moment Time Study (RMTS)

www.vita.virginia.gov
www.dmas.virginia.gov                                         36 36
                  Department of Medical Assistance Services


Contractor Costs (cont)
• None of their costs will be included in
  the Administrative Time Study
• Contractor costs will now be included
  in the Direct Services cost report
• The costs will not be discounted by
  the Time Study percentage, but only
  by the eligibility percentage


www.vita.virginia.gov
www.dmas.virginia.gov                                         37 37
                  Department of Medical Assistance Services


Contractor Costs (cont)
• Contractors who do not perform
  Medicaid eligible medical services will
  be included in the RMTS and the
  Administrative claim
• Any individual the school issues a W-
  2 for is an employee



www.vita.virginia.gov
www.dmas.virginia.gov                                         38 38
                  Department of Medical Assistance Services


Filing Cost Reports for Fiscal Year 2012
• Same deadline for submitting cost reports
  - November 30, 2012
• School divisions are responsible for the
  interim payment amounts from their
  remittance advices
• Same deadline to file claims - by March
  31, 2013 or within one year from date of
  service - whichever comes first. The
  sooner the better.

www.vita.virginia.gov
www.dmas.virginia.gov                                         39 39
                  Department of Medical Assistance Services


Cost Report – Section 1
• General information from the School
  Division
• Unrestricted indirect cost rate (from
  Virginia DOE)
• Time Study Percentages from UMMS
• Eligibility percentages calculated by the
  school division from data received via FTP
  from Xerox


www.vita.virginia.gov
www.dmas.virginia.gov                                         40 40
                  Department of Medical Assistance Services


Section 2 - Time Study Percentages
• The percentages used on the cost
  reports are statewide averages
• Each quarter's statistics are applied
  individually to that quarter's salaries
• This data will be included in the data
  that UMMS sends to the school
  divisions



www.vita.virginia.gov
www.dmas.virginia.gov                                         41 41
                  Department of Medical Assistance Services


Sections 3A to 3D – Quarterly Salary Data
• Raw data is provided by UMMS from data
  sent by school divisions
• Cut and paste the data from UMMS into your
  blank cost report
• School division must fine tune data to include
  changes in staffing. If a practitioner is not on
  the UMMS file, but they are a qualified
  practitioner, their services are billed and they
  participated in the time study, add them to
  the cost report
• Exclude non-qualifying general matching fund
  sources
www.vita.virginia.gov
www.dmas.virginia.gov                                         42 42
                  Department of Medical Assistance Services


Sections 3E to 3H – Quarterly Contractor Data
• Contractors costs will have to be
  added in Section 3E – 3H
• These costs are not reported to
  UMMS now
• These costs will not be discounted
  by the Direct Services Time Study
  percent


www.vita.virginia.gov
www.dmas.virginia.gov                                         43 43
                  Department of Medical Assistance Services


Section 3I – Personnel Costs Annual Summary
• Salary and benefits by job category
  from the quarterly data
• Job category percentages from the
  RMTS are factored




www.vita.virginia.gov
www.dmas.virginia.gov                                         44 44
                    Department of Medical Assistance Services


Section 3I – Personnel Costs Annual Summary
  • Contractor costs by job category
    from the quarterly data – RMTS is
    not factored
  • Results in the portion of personnel
    costs that would apply to Medicaid
    eligible services



  www.vita.virginia.gov
  www.dmas.virginia.gov                                         45 45
                  Department of Medical Assistance Services


Section 4 - Personnel Costs
• Brings forward the personnel costs
  by quarter
• Applies the Indirect Cost Rate
• Introduces the eligibility percentage
  for each program (Medicaid,
  Medicaid Expansion and FAMIS)
• Allocates the cost of each job
  category to each program based on
  eligibility percentages
www.vita.virginia.gov
www.dmas.virginia.gov                                         46 46
                    Department of Medical Assistance Services


Section 5A – Depreciation Schedule (Capital Costs)
  • Capital Costs must be depreciated if the
    cost is over $5,000 and the estimated life
    is at least two years
  • Only straight line depreciation is allowed
  • Depreciated or leased items must be used
    exclusively for medical care
  • A legible copy of all purchase invoices
    must accompany cost report each year


  www.vita.virginia.gov
  www.dmas.virginia.gov                                         47 47
                  Department of Medical Assistance Services

Section 5 – Non-Personnel Costs
(Materials and Supplies)
• Materials and supplies must be used
  ONLY for the delivery of IEP related
  medical services
• Employee travel is only allowable when
  it is for delivering IEP related medical
  services
• Include capital costs calculated in
  section 5A


www.vita.virginia.gov
www.dmas.virginia.gov                                         48 48
                  Department of Medical Assistance Services

Section 5 – Non-Personnel Costs
(Materials and Supplies)
• Allocate the costs based on the
  percentage of total hours that is
  direct IEP related - all job categories
• Apply indirect cost rate
• Allocate each cost to each program
  based on eligibility percentages




www.vita.virginia.gov
www.dmas.virginia.gov                                         49 49
                  Department of Medical Assistance Services

Section 6 – Reconciliation
(Quarter by Quarter)
• Pull personnel costs from Section 4
• Pull non-personnel costs from
  Section 5, divide equally into four
  quarters, and allocate to each
  program
• Calculate federal matching funds
  (FFP)



www.vita.virginia.gov
www.dmas.virginia.gov                                         50 50
                  Department of Medical Assistance Services

Section 6 – Reconciliation
(Quarter by Quarter)
• Enter Interim Payments
• Calculate amount due the School Division
  or due to DMAS




www.vita.virginia.gov
www.dmas.virginia.gov                                         51 51
                  Department of Medical Assistance Services


Certification Statement
• Certified Public Expenditure (CPE) = Total
  cost for the year from Section 6
• A special process allowed for the recovery
  of federal matching funds for qualifying
  expenditures
• Must be signed by responsible school
  division authority



www.vita.virginia.gov
www.dmas.virginia.gov                                         52 52
                  Department of Medical Assistance Services


Cost Settlement
• Cost settlement verifies that costs are
  allowable and have been correctly
  calculated
• Cost settlement determines if the interim
  reimbursement has been less than or
  more than the final reimbursement
• If DMAS owes the school division
  additional funds based on the settlement,
  the amount will be paid in the next weekly
  remittance cycle

www.vita.virginia.gov
www.dmas.virginia.gov                                         53 53
                  Department of Medical Assistance Services


Cost Settlement (Cont.)
• If the school division owes DMAS funds at
  settlement, the amount can be paid by
  direct payment or it may be withheld from
  future remittances.




www.vita.virginia.gov
www.dmas.virginia.gov                                         54 54
                  Department of Medical Assistance Services


Multiple Settlements
• If any of a provider's cost settlements for
  the three programs (Medicaid, Medicaid
  Expansion, or FAMIS) is a negative result,
  all of the payments may be processed
  separately
• The positive amounts may be paid in the
  next weekly remittance cycle




www.vita.virginia.gov
www.dmas.virginia.gov                                         55 55
                  Department of Medical Assistance Services


Enhanced FFP Rates
• As a result of the ARRA the federal
  matching rates were temporarily
  increased, this has expired
• FY 2009         57.29%
• FY 2010         61.59%
• FY 2011         59.71%
• FY 2012         50.00%



www.vita.virginia.gov
www.dmas.virginia.gov                                         56 56
                    Department of Medical Assistance Services


FY 2012 Cost Reporting and Settlement Schedule
  • End of fiscal year – June 30, 2012
  • Cost report forms will be posted on the
    DMAS web page – September 28, 2012
  • Filing reminder from Clifton Gunderson to
    School Divisions – September 30, 2012
  • Deadline for delivering personnel costs to
    UMMS – October 1, 2012



  www.vita.virginia.gov
  www.dmas.virginia.gov                                         57 57
                    Department of Medical Assistance Services


FY 2012 Cost Reporting and Settlement Schedule
  • UMMS distributes personnel cost
    summaries, statewide time study
    results and payment summaries –
    October 31, 2012
  • Cost reports due to PHBV Partners -
    November 30, 2012




  www.vita.virginia.gov
  www.dmas.virginia.gov                                         58 58
                   Department of Medical Assistance Services


FY 2012 Cost Reporting and Settlement Schedule
 • Deadline for FY12 paid claims to be
   included in FY12 settlement – March 31,
   2013
 • Deadline for cost settlements if they are
   timely and complete – May 31, 2013




 www.vita.virginia.gov
 www.dmas.virginia.gov                                         59 59
                  Department of Medical Assistance Services


Interim Payments
• File claims for all covered medical services
  performed for eligible recipients by
  qualified practitioners
• It's a cost based payment system, but
  claims are required by the Medicaid
  Program
• DMAS will be glad to discuss developing
  billing rates you would be comfortable
  using for interim billing
• It's easier to receive a settlement
  payment than to make a refund

www.vita.virginia.gov
www.dmas.virginia.gov                                         60 60
                  Department of Medical Assistance Services


Bill for Services
• CMS requires that you bill for all services
  provided
• Identify your IEP eligibles and the services
  they need
• Make sure you have parental consent to
  bill from day one
• Make securing parental consent a part of
  the process
• Be sure that you bill at a rate that doesn't
  leave you overpaid at cost settlement

www.vita.virginia.gov
www.dmas.virginia.gov                                         61 61
                  Department of Medical Assistance Services


Work the Rejected Claims
• Only paid claims count towards the billing
  requirement
• If a contractor bills for you, follow up to be
  certain that all claims are paid or denied for a
  reason that cannot be remediated
• Review remittance advices for denied claims
• Rework and resubmit denied claims
• Some school divisions are not correcting the
  denied/rejected claims
• If they had corrected rejected claims, they would
  have received greater payment at cost settlement

www.vita.virginia.gov
www.dmas.virginia.gov                                         62 62
                  Department of Medical Assistance Services


Error Codes for Interim Claims
 Most prevalent codes
 Error Code     Error Description
  0030 D         Primary Diag Not on File/Invalid
  0148 D         Rendering Provider not certified to perform
                 procedure
  0178 D         Invalid Diagnosis Code
  0301 D         Duplicate Pymt Req-Same Provider, Same DOS
  0302 D         Duplicate of History File Record-Same Provider,
                 Same DOS
  0308 D         Payment Request Filed after 1 year not Justified
  0318 D         Enrollee Not Elig on DOS
  0970 D         Enrollee not enrolled in covered plan for this svc
                 on DOS

www.vita.virginia.gov
www.dmas.virginia.gov                                                 63 63
                  Department of Medical Assistance Services


Self Audit Process
• This is a process to derive the claiming
  percentage-how many services were
  delivered and how many services were paid
• The tracking document can also be used for
  tracking and monitoring the billing of
  services
• Guidance and forms are on the DMAS
  website



www.vita.virginia.gov
www.dmas.virginia.gov                                         64 64
                  Department of Medical Assistance Services


Sample Selection
• Begin with a list of all Medicaid, Medicaid
  Expansion and FAMIS students that receive a
  Medicaid covered service in an IEP/POC
• Should include students without parental consent
• Arrange the list of students in alpha or numeric
  order
• Select a random sample of 50 students




www.vita.virginia.gov
www.dmas.virginia.gov                                         65 65
                  Department of Medical Assistance Services


Observations from the 50 Selected Files
• Document the number of services prescribed in the
  IEP
• Record the number of services delivered by
  practitioners
• Record the number of services paid
• List all services for each student
• For students without parental consent indicate how
  many sessions were delivered, if you have that
  information, if you do not, use the number of
  sessions in the IEP/POC
• A form for this purpose is on the DMAS website
www.vita.virginia.gov
www.dmas.virginia.gov                                         66 66
                  Department of Medical Assistance Services


Calculations to Determine Allowable Costs
• Divide the units of services paid by the units of
  services delivered for the entire sample group
• This will calculate a percentage of services billed to
  be applied to total costs in order to determine
  allowable costs based on the billing of services




www.vita.virginia.gov
www.dmas.virginia.gov                                         67 67
                  Department of Medical Assistance Services


Calculations to Determine Allowable Costs (Cont.)

• Costs will be disallowed based on the
  percentage of services not billed
• Be certain the costs for all practitioners
  are included in the cost report since some
  non-billing may have been excluded
• Retain supporting documentation, this
  may be needed, in case of an audit



www.vita.virginia.gov
www.dmas.virginia.gov                                         68 68
                  Department of Medical Assistance Services


Transportation Cost Report
First Rule:
  KEEP YOUR HANDS AND ARMS INSIDE THE
  BUS. SIT DOWN AND BE QUIET OR YOU'RE
  GOING STRAIGHT TO THE PRINCIPAL'S
  OFFICE !! I MEAN IT !! SIT DOWN AND
  BE QUIET !!




www.vita.virginia.gov
www.dmas.virginia.gov                                         69 69
                  Department of Medical Assistance Services


Transportation Cost Report
• Pays for the cost of providing
  transportation to and from school on a
  specially equipped (SE) bus for each day
  that an eligible student receives an IEP
  required service
• Since FY08 DMAS has covered FAMIS as
  well as Medicaid and Medicaid Expansion
  students


www.vita.virginia.gov
www.dmas.virginia.gov                                         70 70
                  Department of Medical Assistance Services

Filing Transportation Cost Reports for Fiscal
Year 2012
• Same deadline for submitting cost reports
   - November 30, 2012
• Same deadline to file claims - by March
   31, 2013 or within one year from date of
   service - whichever comes first. The
   sooner the better.




www.vita.virginia.gov
www.dmas.virginia.gov                                         71 71
                  Department of Medical Assistance Services

Transportation Cost Report - General
Information
• Use log to track trips for all students on
  SE buses (one day usually is two trips)
• Match Medicaid/FAMIS eligible students on
  the transportation log receiving IEP
  services on that day and bill for each trip
• Calculate reimbursable cost percentage by
  dividing Medicaid/FAMIS transportation
  paid claims by total trips on SE buses
• Do not use time study, eligibility
  percentage or percentage of services
  billed for transportation cost report

www.vita.virginia.gov
www.dmas.virginia.gov                                         72 72
                  Department of Medical Assistance Services


Non-Personnel Costs
• Capital Costs from the Depreciation
  Schedule
• All other Non-Personnel costs are from the
  school division's records
• Either specific identification or allocated to
  SE buses
• Indirect costs applied



www.vita.virginia.gov
www.dmas.virginia.gov                                         73 73
                  Department of Medical Assistance Services


Depreciation Schedule
• Must be a bus - cars and vans don't
  qualify
• Must be specially adapted buses with a lift
  or child seat restraints
• Wheelchair lift, tie-downs for wheelchairs,
  seat restraints
• Depreciation or lease cost for each bus
• Bus fully depreciated ? - no expense


www.vita.virginia.gov
www.dmas.virginia.gov                                         74 74
                  Department of Medical Assistance Services


Annual Salary, Benefit and Contract Costs
• Drivers and substitutes salaries are from
  school division records
• Mechanics and maintenance personnel or
  contract costs, fuel and insurance may be
  allocated to SE buses using the percent of
  special transportation buses to total buses




www.vita.virginia.gov
www.dmas.virginia.gov                                         75 75
                  Department of Medical Assistance Services


Personnel Costs, Indirect Costs and Allocation
• Personnel costs recapped
• Indirect costs applied
• Eligible trips applied for each program




www.vita.virginia.gov
www.dmas.virginia.gov                                         76 76
                  Department of Medical Assistance Services

Reconciliation –
Personnel, Non-Personnel and Federal Share
• Combining of costs qualifying for each
  program
• Total Computable costs calculated
• Federal share percentages applied
• Subtract Interim payments = balance due




www.vita.virginia.gov
www.dmas.virginia.gov                                         77 77
                  Department of Medical Assistance Services


Certification Page
• Specify Certified Public Expenditure (CPE)
• A special process allowed for the recovery
  of federal matching funds for qualifying
  expenditures
• Must be signed by responsible school
  division authority




www.vita.virginia.gov
www.dmas.virginia.gov                                         78 78
                  Department of Medical Assistance Services


Data Collection Forms
• Weekly ridership log for each bus - log
  could be signed by bus monitor as well as
  driver
• Recap of weekly statistics for each bus - A
  Big help
• Available on the DMAS website




www.vita.virginia.gov
www.dmas.virginia.gov                                         79 79
                  Department of Medical Assistance Services


Transportation
• The key to success is the matching of
  student trips with billed medical services
• If you didn't bill the medical services or
  match the services to the trips, you can't
  include the trips in the numerator




www.vita.virginia.gov
www.dmas.virginia.gov                                         80 80
                  Department of Medical Assistance Services


Contact Information
                                DMAS
                   Chandra Shrestha, Ph.D.
             Health Care Reimbursement Specialist
                        804-371-2446
             chandra.shrestha@dmas.virginia.gov

                                 DOE
      Amy Edwards, Medicaid Specialist, 804-692-0150
             amy.edwards@doe.virginia.gov

                        PHBV Partners, LLP
       Anne Morrow, Audit Manager, 804-270-2200
             anne.morrow@phbvpartners.com

www.vita.virginia.gov
www.dmas.virginia.gov                                         81 81
                  Department of Medical Assistance Services


Contact Information
Claims issues
DMAS Provider Helpline: 1-800-552-8627

Systems issues and FTP and password
 resets
Xerox Helpline: 1-866-352-0496

FTP mailbox for eligibility data
https://vammis-filetransfer.com

www.vita.virginia.gov
www.dmas.virginia.gov                                         82 82
                  Department of Medical Assistance Services


Opportunities for Improvement
• Bill for all of your services - low claim
  billings result in low claiming percent,
  provider’s costs will be partially disallowed
• All providers whose salaries are included
  in the cost report must bill for services
  provided to all eligible recipients
• Have at least a 90% participation rate in
  the time study (RMTS)



www.vita.virginia.gov
www.dmas.virginia.gov                                         83 83
                  Department of Medical Assistance Services


Our Biggest Challenges
• Matching students with IEPs to the
  services delivered to see that
  documentation and billing occur
• School divisions should invest adequate
  resources to receive full reimbursement
  from the Medicaid in Schools Program




www.vita.virginia.gov
www.dmas.virginia.gov                                         84 84

				
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