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Medicaid/Education Reports August 8-9, 2012. Address Medicaid.

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Presentation on theme: "Medicaid/Education Reports August 8-9, 2012. Address Medicaid."— Presentation transcript:

1 Medicaid/Education Reports August 8-9, 2012

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3 Address Medicaid

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7 Diagnosis Code

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11 Enter new billing

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17 General

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23 PDF

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34 Random Moment Time Studies

35 Inappropriate Responses to RMTS Example 1: (Would not be coded as Medicaid allowable cost. Needs more detail.) 1.Who was with you? No one 2. What were you doing? Duty 3.Why were you doing this activity? Assigned duty 4. Is this activity regarding a Special Education student? No

36 Inappropriate Responses to RMTS Example 2: 1.Who was with you? A group of people charged with carrying out the work of an establishment 2. What were you doing? Inputting the last “moment in time” documentation instead of using my scheduled paperwork time to prepare for the two IEPs that I have next week. 3.Why were you doing this activity? You keep sending me these “moments.” I am itinerant and MCS will not provide me with a computer, IPad, or other internet access to use during treatment blocks of time. Scheduled office time is the only time I can complete these “moments.” 4. Is this activity regarding a Special Education student? NA

37 Preliminary Results of 1 st RMTS February - March Response rates – 85% required (3000 moments per “pool”) » 92.13% - Direct Services » 83.20% - Care Coordination » 78.60% - Personal Care » 89.47% - Admin

38 PCG’s Time Study Team – “less than appropriate responses were submitted.” A number of inappropriate responses were received by staff participating in the RMTS. Two areas of concern: Incomplete responses Rudeness/Frustration

39 Preliminary Results of 1 st RMTS February - March Service percentages responses » 49.16% - Direct Services » 4.24% - Care Coordination » 20.21% - Personal Care

40 Cost Settlement Calculation Example – Neutral WV: Introduction to Medicaid Cost Based School Based Health Services 40 1.0Total Costs of Eligible SBHS Provider Costs (county’s cost)$1,000,000 2.0Indirect Cost Rate115.00% 3.0Total Costs of Eligible SBHS Provider Costs$1,150,000 4.0RMTS Direct Medical Percentage Results (Statewide results)65.00% 5.0Direct Medical Services Costs$747,500 6.0Application of Medicaid Eligibility Rate (IEP Ratio) (county’s)50.00% 7.0Medicaid Direct Medical Services Costs (for the county)$373,750 8.0Medicaid Interim Payments Received (by the county)$373,750 9.0Medicaid Cost Settlement (at the end of the year – July 2013)$0

41 https://easyrmts.pcgus.com/RMTSv2/LoginCheck.aspx

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