· Welcome and Introductions
In attendance: Renee Bullerman, Valerie Carlson, Annmarie Suess, Jo Pantzke, Kelly Wanzek, Jill Bleyenburg, Dawn Sandbult, Lori Bakken, Melissa Raverty, Christine Risell, Edith Gates, Donnita Bennett, Michelle Curtis, Jane Groen, Anne Holcomb, Tegan Gillund, Katie Roiger, Becky Ehling, Pat McLain, Heidi Link, Denise Clarke, Kellee Pudenz, Cheryl Hartman, Anneke Nelson, Mary Carter, Lori Lee, Kellie Parker, Brenda Marcotte, Betty Smith, Dellynne Monson, Martha Ritter.
ITV: Becky Stromberg, Hutchinson and Jana Smith, KMS
· MA consents – mailing vs. face-to-face
Raise of hands showed MA consents are coming in very well. Mailings this year received a positive response. Some schools still using face-to-face conversations to obtain consents.
· PCA Billing
- PCA Time Studies – what MDHS is looking for – Handout M
Reviewed Personal Care Service Time Study (10-day use) and discussed how to complete correctly. Example will be on the SW/WC website early next week. Recommendations: Make sure PCA’s initial each time the service was provided and sign the last page indicating average total # of minutes per day for MA billable PCA services.
- New Time Studies for Data Collection for Level 1 Behaviors – what MDHS is looking for – Handout – DRAFT
In an effort to try to assist case managers with data collection for both MA and FBA, a new Time Study Data Collection sheet for Behaviors was distributed. MDHS is requesting clearer data collection and documentation regarding all-day, every day behavior observation and redirection for those students with a medical diagnosis and qualified PCA services. This document will be distributed and discussed also with case managers at the monthly Coordinator/School district meetings. Coordinators will further clarify the need for this documentation and how it will assist the case manager with other required reports for Special Education.
- IEP Writing for Child Specific PCA – what MDHS is looking for – Handout – IEP for Susie Girl Example: This is only an example of how an IEP should be completed for Child Specific PCA services. First and foremost, the medical diagnosis should be included in this area if it relates to MA billing. The areas are delineated by: Behavior Support, Academics, Other Health Related Services, and ADLs. As much explanation with examples and severity of behaviors should be outlined in this area. The information included should be directly aligned with the Time Studies.
¨ Academics
¨ ADLS
¨ Behaviors/Vulnerability
¨ Other Health Related functions
¨ Special Transportation: Reminder to include the medical diagnosis and explanation of why special transportation is required for student in order for it to be MA billed.
- PCA Activity log – Handout N – Reiterated the importance of completing the PCA activity logs so that the follow criteria required by MDHS for MA PCA billing.
· Billing in General – what errors we are seeing – Handout – see attached. Discussion of current issues we are seeing that will affect MA billing. Discussed what needs to be done and how to make corrections in the areas of Activity logs, Mini Time Studies, IEPs and School Psych activity logs.
· Billable services over 21 – Handout – not attached. I investigated the question whether IEP health related services are billable for a student who is 21 years old. If a student is receiving IEP services, and they are over the age of 21, we cannot MA bill for those services. Services up to the age of 21 are billable, but will be denied the day a student turns 21. This situation may occur when some students in transition programs can be enrolled through age 22. There are some adult services that are provided from community providers (not schools) that possibly could be paid for through the MHCP program the student is enrolled in, and if the service meets the medically necessary criteria. Should call Jenny Roth at MDHS if you have questions regarding your program.
· Understanding EDRS related to MA billing – Discussion on how to enter bus monitors on EDRS and how it relates to 3rd party billing. Under recommendation from George Holt, MDE, I have contacted Kelly Wosika at MDE to see if she can provide us written information about using PTC 61 on EDRS and how it relates to UFARS 161 and 723. Ultimately, using this breakdown would allow for increase in revenue for school districts. Follow-up (11-15-13 – MDE could not produce any written explanation or clarification of how the PTC 61 should be used in EDRS for 3rd party billing. Recommend if questions to contact Kelly Wosika at MDE - 651-582-8855 or .
· Nursing Services – Handouts available upon request
a. School Nurse Organization of MN – Annual Conference – PowerPoint Presentation
Provided PowerPoint handout from the School Nurse Org. of MN Annual Conference held on November 2, 2013. This PowerPoint was presented by Janet Lowe, RN, LSN, CPNP, MA for St. Paul Public Schools. If you have questions regarding this, please contact Janet at 651-767-8189 or . I have worked with Janet over the past 10 years and she is very knowledgeable regarding the role of school nurses and MA billing. A copy of this handout can be requested. Just email me. Copies have been emailed to nurses who requested from our meeting.
· Guidelines ONLY for Documentation – Handouts available upon request - I contacted each of the following organizations and request “guidelines” for documentation. These guidelines apply to community based services; however, may be helpful for providers in the school setting. You may request copy from me.
a. AOTA – Occupational Therapy
b. ASHA – Speech-Language Pathology
c. APTA – Physical Therapy
· NEOCertified Mail – importance of the MA Eligibility Spreadsheet – Discussed how well the NEOCertified Mail is working for sharing confidential information. Thank you for using. It was noted that you must use an email sent from Dellynne or myself to respond back to us. Also, once you have selected the attachment on your browser using the dropdown menu, you also need to click the “Attach” button before sending. Some of the documents are too large, and I will have to reduce size to send.
· Administration Invoices/Fees – Administration invoice payments were due October 1, 2013. If you did not receive one, you need to contact Jesusa Williams at MDHS. Also, if the school/billing address has changed since MA billing commenced, that needs to be updated also. Please let us know if there are any issues regarding this. Jesusa did contact me on two school districts where this occurred, and the situations were rectified.
· Settle-up
a. Memo from Judy Ekern – Final Rates – Handout – The 11-12 final rates have been entered in the MMIS system and a formal request to reprocess 11-12 paid IEP claims has been submitted to the Claims Division. A list of schools whose 11-12 paid IEP claims will be reprocessed was attached to the email. All SW/WC Service district members have been account for. These reprocessed 11-12 claims will appear on a Remittance Advice (RA). We will reconcile the RA for your school district. Claims Division will begin to process the 11-12 paid claims with the pay run starting November 15, 2013, with the warrant being issued on December 3, 2013. MDHS has advised to stop submitting claims for a short time period so only final paid claims for 11-12 will appear on the RA making it easier for Dellynne and myself to reconcile.
Your final rates for 11-12 SY will be your interim billing rates for 13-14SY. We will update SpEd forms accordingly as soon as all 11-12 claims have been reprocessed. Based on actual time and encounters, your final rates may have been higher or lower than the interim rates for 11-12. During the reprocessing, all 11-12 claims are taken back, and then MDHS reissues the claims at the FINAL rate for 11-12. Depending on the change in rates, your school district may receive more monies back or you may owe money. Any owed monies are deducted toward future claims. Again, we advise school districts to not include MA monies in their budgets and the rates are unpredictable due to fluctuations in salaries, time, encounters, changes to legislation and other unforeseen issues from year to year. Think of MA dollars as “icing on the cake” – an extra bonus.
b. MA Billing Rates – Handout – Asked group to please read through the handout from Fall 2013 to assist with understanding how rates are determine for MA billing. Dellynne and I will recalculate rates with MDHS based on data collection from September through December prior to billing to make sure there are no major discrepancies.
· 3rd Party Billing FORUM – Tuesday, April 29, 2014 at MDE – This year’s FORUM will include breakout sessions for specific IEP health care providers in addition to coordinators and billers. Highly encourage attendance as this day-long conference because it will be covering a large amount of information including upcoming changes to some IEP billable services. The 3rd Party Billing FORUM runs back-to-back with the School Nursing Forum on Wednesday, April 30, 2014.
· SharePoint information – Not available to date. – Just posted on SharePoint PM of 11-12-13. Only denials from 5 insurance company’s to-date. Log in for SharePoint is: https://collaboration.education.state.mn.us Dellynne and I will be obtaining all your insurance denials before billing.
· MA eligibility spreadsheet: It is imperative that school districts use the MA Eligibility worksheets to keep us updated. We rely solely on these worksheets to guarantee documentation is completed prior to any billing. Cannot stress enough the importance of getting these completed and sent to us through NEOCertified Mail. MA billing will be delayed or even missed if this information is not communicated. We try our hardest to maximize MA reimbursement for every school district. This can only be accomplished if there is good communication between all individuals: 3rd party billing coordinators, providers, SpEd coordinators and business managers. There is a great deal of coordination required to meet criteria for successful MA billing. We are constantly trying to find “tools” to assist school districts with this process.
· Miscellaneous Issues – Please do not send us any information that does not pertain to a MA billable student. We do not need consents or other documentation that cannot be used for billing. We only need the scanned PCA and ST logs (where applicable), consents (if insurance information has changed). Thank you.
· SpEd forms – via “WebEx” – Tonia Czech – Tonia communicated via “Bridgette” to demonstrate how to run specific reports including custom reports. Also demonstrated other areas in SpEd forms and how to use/access data useful for both Special Ed and MA billing. It was noted that the “U-tube" tutorials were focused on special education IEP’s vs. MA. If you have issues with Sped forms, you may contact your SW/WC Service Sped Coordinator for your district or Dellynne or me to assist.
Reminder for the couple of schools who will be reconciling their RA’s (835x12) for settle up to use the “”Update red (paid) claims” when matching claims. Only used for settle up RA.
· Meeting dates – Meeting dates set for the remainder of the year:
February 12, 2014 – Marshall
May 14, 2014 – Marshall
Meeting concluded at 11:45 followed by lunch and networking time.
1