7 School Medicaid Inefficiencies and How to Eliminate Them


Save Time on School Medicaid Billing

School districts across the country rely on Medicaid reimbursements to fund special education programs and services for their students. However, the entire Medicaid workflow from data readiness and pre-documentation through logging, billing, and claims management can be complex and time-consuming, often requiring significant administrative resources and expertise.

But here’s the thing – we know some of these challenges are costing your team time with tedious data entry and lack of clarity. That’s why we’ve recently identified some of the most common challenges school districts are facing when it comes to their Medicaid programs, and we’re excited to share tips for optimizing these processes.

Let’s dive in and take a closer look at some of the challenges and how to address them!

Challenge #1: Medicaid Eligibility and Documentation

One of the biggest challenges faced by school districts is determining which students are eligible for reimbursement and documenting the services provided. This often requires significant administrative resources and time spent tracking down and verifying student data, obtaining parental consent, and maintaining detailed records. In addition, districts often work with vendors who are unable to integrate platforms resulting in the majority of their time being taken up by hand entering student data. In some instances, this task alone becomes a full-time job!

Pro Tip: We recommend implementing a streamlined data management system that integrates with your existing student information and special education systems. This includes any additional platform that might be used such as behavior or nursing specific documentation systems. The right billing vendor can access these providers logs directly which eliminates duplicate entry by staff. Additionally, partnering with a Medicaid billing vendor that provides comprehensive eligibility determination and documentation support can help reduce administrative burden and improve accuracy.

Challenge #2: Billing Errors and Denials

Another common challenge is the risk of billing errors and denials, which can result in lost revenue and additional administrative burden. Consistent and significant billing errors can also raise a flag at the state level which can potentially invite an audit to your doorstep.

Pro Tip: We suggest looking at errors and denials to identify themes to target your training. Another option is automating coding and documentation verification, as well as ongoing claims management and denial appeals support—if your Medicaid vendor supports this. Partnering with a Medicaid billing vendor that has a strong track record of successfully managing claims and minimizing denials can help reduce administrative burden and improve revenue recovery. The key is to build a solid foundation together and create a process in which your program can be built upon.

Challenge #3: Compliance and Audit Risk

As previously mentioned, school districts can face compliance and audit risk related to their Medicaid programs, particularly if they are not following all applicable rules and regulations. It can often be difficult to stay current with the state changes or even know who your primary point of contact should be to get your questions answered.

Pro Tip: It may be time to increase your Medicaid IQ! Implementing a robust compliance and audit management system includes ongoing monitoring, staff training, and documentation management—identify internal experts and start developing relationships at the state level to always ensure compliance. Your Medicaid vendor should also be your partner in ensuring your district is following all federal and state regulations. Having this partner act as your Medicaid Liaison removes a stressful item off your task list while simultaneously keeping you informed and your district up to date.

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Challenge #4: Staff Training

Providing adequate training for staff responsible for documenting and billing in the system can be a challenge. Staff members may have varying levels of experience and understanding of Medicaid regulations and requirements, which can lead to errors and compliance issues. With the staffing crisis that has swept the nation, keeping new staff in the loop is often difficult as well.

Pro Tip: We suggest implementing a comprehensive training program that includes initial and ongoing training sessions, as well as opportunities for staff members to receive individualized coaching and support. We encourage districts to offer a variety of training materials such as tip sheets, guides and audio/video options. At the administrative level, we suggest pulling a provider report on a reoccurring basis that allows you the opportunity to view your list of current providers and edit whenever applicable. This means removing staff no longer at the district and setting up new or sub staff.

Challenge #5: Obtaining and Checking Prescriptions

If you are in a state in which prescriptions/physician authorizations are required, this one’s for you. Obtaining and checking prescriptions for eligible services can be a complex and time-consuming process, particularly if the school district is working with multiple healthcare providers. Keeping track of prescription start and end dates is one challenge but waiting for the signed documentation to be sent back to you is another.

Pro Tip: We recommend implementing a centralized system that allows you to track and manage all prescriptions and related documentation in a single location. Additionally, partnering with a Medicaid billing vendor that provides comprehensive prescription management services can help reduce administrative burden and improve accuracy. This also allows for services to be submitted with more frequency rather than having to be held awaiting this compliant piece of the puzzle.

Challenge #6: Parental Consent

Obtaining parental consent for eligible services provided to their child can be a significant challenge. Particularly if parents are difficult to reach, do not respond to consent requests, or have concerns or misunderstandings about the services being provided.

Pro Tip: We suggest clear and concise communication with parents about the services being provided, as well as timely follow-up and support to address any concerns or questions they may have. Having a Q&A form readily available helps both the parent/guardian as well as the provider who is seeking consent and might be uncomfortable handling this sensitive information. The use of electronic consent forms also helps streamline the process and reduce the risk of errors or lost documentation. However, electronic consent isn’t allowed in every state. Consult with your State Education Department or Medicaid vendor about forms of collection.

Challenge #7: Access to Reporting and Analytics

Accessing and analyzing Medicaid logging and reimbursement data can be a struggle due to insufficient data management systems, lack of staff expertise in data analysis, or limited resources for data management and reporting.

Pro Tip: We recommend creating and/or accessing reports that provide your Medicaid billing and reimbursement data, staff logging habits, caseloads, and anything that can help drive better decisions in your district. Ideally, this data should be “real-time” in easy-to-understand dashboards, so you are able to check it at your convenience.

In conclusion, optimizing school district Medicaid programs and billing processes is a complex and ongoing effort that requires careful attention to detail and a deep understanding of all applicable rules and regulations. Additionally, partnering with a trusted Medicaid vendor, like Relay, can help school districts achieve these goals while reducing administrative burden and improving overall program performance. We would love to hear more about the challenges you may be facing and offer our experience and knowledge to better support your district!

Relay and School Medicaid Billing

Relay provides some of the best information you can find in school based Medicaid, including state-specific Medicaid facts and links to national resources, like Healthy Schools Campaign that all provide an in-depth analysis of billing requirements.

Get in touch with the Relay team to help you on your Medicaid state plan just review your current Medicaid program—regardless of you Medicaid billing vendor.

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