School Medicaid Billing Headaches: Why School Districts Need to Rethink Their Approach


Time to Switch Your School Medicaid Vendor

We understand the challenges that school districts face when managing Medicaid reimbursements for billable related services. It’s a complex process that requires a lot of attention to detail with many factors that can impact the success of your program. This point in the school year is THE best time to start evaluating your current vendor and/or workflow and seeing if it’s time for a change.  

  1. Are you experiencing Medicaid staff turnover?  

One of the most common reasons that school districts decide to rethink their approach to Medicaid is because of team turnover or retirement. When a key member of your team leaves, it often results in taking with them the institutional knowledge of the program and the process they have been implementing. The silver lining here is this can be an opportunity to reassess your program and identify areas for improvement.  

Does your vendor work with you to create consistent and clear processes? Does your Medicaid partner offer training so that new hires can better understand the program and the platform they are using? If you reach out for support, are you left waiting long periods of time for a response?  Without proper training and support, a program can quickly become chaotic and disorganized when a staff member leaves and someone new starts. 

  1. Have you recently changed your SIS or IEP systems in your school district?  

Finally, if your SIS/IEP has recently undergone a major change, it’s an opportunity to take a step back and evaluate your Medicaid reimbursement processes. Large software implementations can be challenging and disruptive, but they also offer a unique opportunity to rethink and optimize a wide range of processes across the school district. 

For example, if your district is implementing a new SIS/IEP system, you may be able to identify areas where the new system can be integrated with other tools and software solutions, such as Medicaid reimbursement software. This can help streamline workflows, reduce the risk of errors, and improve overall efficiency. 

  1. Are your staff dealing with tedious double data entry?  

According to a survey by EdWeek Market Brief, nearly half of K-12 district leaders said that managing and analyzing data was one of their biggest challenges, and more than one-third said that they spend between five and ten hours per week on data-related tasks. That’s a significant amount of time that could be better spent on other tasks, such as providing direct services to students or collaborating with colleagues to improve outcomes. 

In school-based Medicaid programs, double data entry can include student demographics, Medicaid eligibility, IEP information, and often even services themselves. This can lead to frustration among admin and staff, incorrect information due to human error, and missing billing opportunities. If your current vendor is not willing to automate data syncs with your SIS/IEP systems, it may be time to look for a new vendor who can provide this service. When your providers voice concerns about the amount of time it takes to manage their caseload, hand enter goals & objectives, or log services, it’s important to listen to their feedback and look for ways to increase efficiency.  

Fortunately, there are solutions available that can help improve the process and reduce the amount of time spent on double data entry tasks. For example, Relay can often automatically sync data between different systems, eliminating the need for manual data entry. 

New Webinar: How to Ditch the Tedious Data Entry in Your Medicaid Program

From logging to reporting, find out how to make sense of all the data going in and out of your district’s Medicaid systems this April with School Medicaid experts. 

Save Your Spot!
  1. Can you measure the performance of your school Medicaid billing program?  

Speaking of data, are you aware of the overall health of your Medicaid program? How is your district doing? If you’re not sure whether the Medicaid revenue is increasing, decreasing, or being maintained year over year, it’s time to take a closer look. Having a clear understanding of your financials helps to make informed decisions and budget appropriately.  

Make sure your Medicaid approach includes user-friendly ways to access data, like overall revenue, provider activity, and denied claims—so you can see gaps and quickly resolve issues to avoid any panic at the end of the year. With these data insights, not only will you be able to see how well you are doing, but also potential revenue streams you may be missing out on altogether.  

  1. Is your data secure?  

Significant issues can arise when your vendor is experiencing performance or security incidents. This can be a major concern for school districts, as it can put sensitive student information at risk. In fact, a recent study by states that K–12 cyberattacks are on the rise and can cost districts millions of dollars to repair. 

These incidents can have serious consequences for student data security, leading to the exposure of personal information, identity theft, and other potential harm. It’s critical for school districts to take vendor performance and student data security seriously. 

Make sure your vendor prioritizes security. Is this platform HIPAA and FERPA compliant? Is there a data policy in place? Do they have a Cyber Security Specialist on staff to respond immediately to concerns? By prioritizing student data security and taking proactive steps to address vendor issues, you can help ensure that your district’s Medicaid reimbursement program is operating securely and effectively. 

  1. Do you have access to a Medicaid Liaison?  

You need to be able to rely on your vendor to provide the support needed to be successful. We have all had the misfortune of dealing with bad customer support at some point in our lives. You know the feeling: you’re on hold for what seems like an eternity, listening to elevator music and wondering if anyone will ever answer the phone, that is, if you can even get anyone on the phone! 

Unfortunately, bad customer support can be a real issue when it comes to managing Medicaid. If you’re experiencing issues with your current vendor’s customer support, it’s important to advocate for yourself and your district. Start looking for another vendor that can provide you with a Medicaid Liaison—a person who stays current on your state’s program and will always be a phone call or email away from getting you help!  

It’s also important to make sure that your team is continually learning and growing their Medicaid IQ. If you’re not seeing progress in this area and getting support from your vendor, it may be time to look for new training resources or a partner who can help you stay up to date with the latest best practices. 

  1. Is your school Medicaid program changing at the state level?  

Another opportunity to rethink your Medicaid approach is when there is a SPA change at the state level. This can be a chance to reevaluate your program and identify ways to improve efficiency and effectiveness. 

When a state goes through a State Plan Amendment (SPA) change regarding school Medicaid, it can be a confusing time. A SPA change typically involves updates or revisions to the state’s Medicaid program, which can affect the way that school districts are reimbursed for Medicaid-eligible services. 

During an SPA change, school districts may experience uncertainty and confusion about what the changes mean for them. They may need to adjust their processes and documentation to comply with the new requirements, which can be time-consuming and challenging. These changes are extremely less overwhelming with a Medicaid Liaison bridging that gap of information and working with you to keep your program compliant.  

Honestly, it often feels insurmountable to even consider taking a new approach to school-based Medicaid due to all the work that is already on your plate. However, it’s important to be proactive in identifying areas for improvement and to be open to new ideas and solutions. We have only provided a few examples of when and why to switch and certainly others are going through your mind as you read this! By working together, we can create more efficient, effective programs that benefit school districts at every level. 

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 your Medicaid billing vendor.

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