How to Manage Medicaid Administrator Transitions


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As you are probably aware, there have been major shifts and changes within the workforce in the past few years. In fact, the number of U.S. workers who quit their jobs reached a new high in November 2021, when 4.5 million people resigned. This has come to be known as “The Great Resignation.”

Perhaps you’ve seen the turnover first-hand in your own school or district. It wouldn’t be a surprise, as school districts across the country have not avoided The Great Resignation. In a study completed by Education Weekly, many people in the education field say they are working nine or even 10 hours a day. This is leading to school and district administrators quitting their positions, and in the case of school Medicaid administrators who leave suddenly, it can lead to a significant loss of Medicaid revenue or other breakdowns in your Medicaid billing program.

The Importance of an Electronic Filing System

As important as your Medicaid administrators are, you can’t expect them to stay at the same district or in the same position forever. A certain amount of turnover is to be expected and prepared for. If you’re reacting to their departure rather than preparing for it, you’re only serving to make the situation harder for yourself.

So, what’s the solution? It’s something you should be making efforts to incorporate within your district’s Medicaid team anyway.

Trainings, Timelines, and Procedures

Imagine if a third-grade class was learning about the solar system when their teacher resigned and was replaced by a substitute who thought the children should be learning about plants instead. This would be confusing for the students and could lead to them never finishing their course on the planets. They’d arrive next year in fourth grade without the fundamentals of the solar system the other kids have. In order to avoid a situation like this, all kids within your school and probably within the district as a whole learn from the same curriculum.

Let’s apply this same mentality to your Medicaid team members. Your district’s Medicaid funds are too important to leave to chance. In addition to establishing a well-done electronic filing system, you should also ensure that your Medicaid administrators have gone through the proper training to fully understand what timelines and office procedures they need to follow in order to get claims received successfully.

Nothing should be left to chance, and nothing should be based on one person’s whims or opinions either. Establishing a systematic approach to every step of the Medicaid reimbursement procedure is essential to both getting it right and making sure there’s no downtime when the role is left by one and filled by another. Think of this as your team’s playbook!

How to Ensure Team Members Remain in Compliance as They Transition into Their New Roles

Sometimes called either a Medicaid Coordinator or Medicaid Implementer, this person implements the School-Based Services Program and ensures program integrity. This professional is expected to know both Medicaid policy and special education rules and regulations.

When taking on a new Medicaid administrator role, the number one priority to have at front of mind is maintaining the playbook mentioned above. This playbook should outline roles and responsibilities for all personnel involved. This will include documents needed to ensure the program is compliant and meets all business rules, like:

  • Parental notification and parental consent forms
  • Maintaining licensure and certification of staff
  • Schedule of claims to be submitted
  • Schedule of RMTS (Random Moment Time Studies)
  • Due date of cost pools
  • Tracking all providers are included in both RMTS and direct claiming
  • Monitoring for Billing Completeness and Accuracy
  • Following up with providers with incomplete billing (directly or through a designated local educational agency, or LEA, contacts)

Common Mistakes to Avoid During Transitions

While making a transition, there are a few common mistakes to avoid. For one, you will most certainly want to verify that the new staff being brought on meet all necessary qualifications, including a current license, certification, and any other program requirements.

A too-common mistake is not having a complete, up to date, Medicaid billing procedures manual to reference. The manual should be updated at least annually to reflect the latest district Medicaid billing policies and procedures.

Another common mistake is letting either your Billing Compliance or Quality Assurance Plan fall to the wayside as you ramp up the new team member into their position. These are far too important to be pushed aside as an afterthought.

After hiring a new Medicaid administrator, be sure to spot-check billing for accuracy and quality to ensure they are doing their job correctly. Additionally, this is the best time to update or establish your internal audits.

The Best Medicaid Administrator Transitions are Made Possible with CompuClaim

School-based Medicaid claiming programs have long been plagued by missed revenue opportunities, inefficiencies, compliance issues, and a lack of integration with other technology systems.

“No dollar left behind!” isn’t a pledge you should push aside when a new team member comes aboard. We’re here to make sure your school gets the needed funds you are entitled to, no matter who is currently at the helm of your ship.

Without electronic records, your transition won’t be a smooth one and claims will be missed. As an intuitive Medicaid Workflow Solution, CompuClaim’s cloud-based services utilize our software solutions to help you keep records of all your electronic documentation. We ensure that no Medicaid dollar gets left behind for education service agencies, school districts, and school boards.

We invite you to contact us for a consultation before a transition in your district in order to learn more about our services and how we can help you succeed and collect every Medicaid dollar you’re entitled to.