Quick Tips for Billing Medicaid in Schools

Schools are able to receive Medicaid reimbursement for health and related services provided to students who are enrolled in Medicaid, have services prescribed on his or her IEP, and are covered under the state Medicaid plan. 

Although the federal Medicaid program requirements apply to all states, Medicaid is administered jointly by the federal and state governments.  When reviewing opportunities for Medicaid reimbursement, it’s important to have all of the federal and state data requirements met for Medicaid to reimburse for IDEA-related services.

What Do Districts Need?

1. Verify student’s Medicaid eligibility to ensure they are currently enrolled in Medicaid.
2. Signed Consent to Bill Medicaid/Consent to Release Confidential Information document on file.
3. Delivered services are medically necessary and are listed on the student’s Individualized Educational Plan (IEP). 
4. The specific medically necessary services are listed in the state Medicaid plan and meet federal Medicaid statute.
5. The school district or local educational agency (LEA) is authorized by the state as a qualified Medicaid provider.
6. Service providers have all licenses and state requirements up-to-date for Medicaid billing.

Quick Tips For Success!

1. Ensure provider compliance by conducting annual professional development on the documentation requirements, procedures, and case management responsibilities.
2. Ensure all potential Medicaid claims are being documented on a regular and consistent basis.
3. Confirm all claims submitted by interns and assistants are approved by a supervisor.
4. Ensure claimed services correlate to the services listed in the student’s current IEP.
5. If available, submit round-trip, special transportation claims for any days in which students receive a medically necessary service. 

How EmbraceDS® Helps!

1. User-friendly interface allows providers to document delivered services and special transportation claims.
2. Automated, monthly accuracy reports are sent to all providers who are responsible for documenting delivered services, allowing users to compare IEP service minutes with documented service minutes for each month.
3. Excellent customer service representatives are available to answer any questions relating to Medicaid claims and EmbraceDS® program functionality. 
4. State and federal requirements are built into the Embrace® system to ensure districts are audit ready.