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PAIU Workgroup Meeting School-Based ACCESS Program

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.

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PAIU Workgroup Meeting School-Based ACCESS Program

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  1. PAIU Workgroup MeetingSchool-Based ACCESS Program February 7, 2013 www.pcgeducation.com

  2. Agenda • Accomplishments • SBAP Update • Service Logs • Billing volumes • Exception Report Update • Claiming Update • RMTS Update • MCRCS Update • Medicaid Eligibility • Next Steps – Action items

  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 SBAP Service Log Activity (through 2/5/2013) Services

  4. PA SBAP – Billing History (July, Aug, Sept)* Service Logs Processed * Only months of July, Aug, Sept were processed, awaiting 2013 rates to be approved to process logs Oct 1 or later

  5. 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

  6. PA SBAP – Exception Report Detail

  7. 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, 2013 • Response has been strong • 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

  8. 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

  9. 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

  10. 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 • 1/31, 2/1, 2/4, 2/5, 2/6, and 2/8 • Dates & times posted on Training Calendar for registration • 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: • Capture all allowable, reimbursable costs for both quarterly administrative claiming and annual cost reporting • If costs aren’t entered MAC claims and the cost report cannot be completed, impacting ACCESS reimbursement for districts

  11. Medicaid Matching • PCG conducts a monthly Medicaid match on all students in EasyTrac • 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 • For secondary, or enhanced, matches PCG staff evaluate the detailed records from both files to determine if a match truly exists • 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 another • Worst case scenario with an auditor is to have a Medicaid ID assigned to wrong student and claims are being submitted • Nicknames, shortened names, hyphens, apostrophes, middle initials, etc are all causes for matches to fail • Process is for district to engage parent and have misspelling or name changes updated in DPW or district files, whichever is incorrect

  12. PCG Representative Assignments

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