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Maine State Billing Services, Inc

By Albert Smith,2014-06-18 12:01
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Maine State Billing Services, Inc

    Vital Information

    For the SBRS MaineCare Program

    Please Keep In Mind…

    1. District Information Form*: Please help us update our records by filling out the form with the current

    school year’s information.

    2. Practitioner Packets Form: Please let us know how many practitioner-training packets you will need

    for the upcoming school year.

    * Please fill out these forms and mail or fax them back to us at (207) 698-9941.

3. IEP: Please keep annotated IEP’s (or copies) for students for whom you have received MaineCare

    reimbursement for five years for audit purposes.

    4. Authorization of Services: You’ll also want to make sure that Speech, OT, PT and rehabilitative

    assistance are specified in an IEP and authorized each year by a physician or licensed practitioner of

    the healing arts (therapist) operating within the scope of his/her license. We’ve included a sample of an

    authorization form for your review and use. Recent federal audits in surrounding states have

    emphasized the need for documentation of medical necessity through these authorizations. When

    authorizations have been found lacking during audits, paybacks have resulted.

5. Service Records: Even though Maine’s School-Based Rehabilitative Services Program is a per diem

    model (pg. 10 in Regulations), Service Records are key documents for post-payment audits. Please

    make sure each practitioner delivering covered services is documenting his/her time and services on

    the correct service record and therapy notes forms. We suggest that you send us documentation of

    service records as your practitioners complete those records. If you have not been utilizing our service

    in this regard, please feel free to begin to do so. Recent federal audits in surrounding states have

    emphasized the need for documentation of service delivery via Service Records. When Service

    Records have been found lacking during audits, paybacks have resulted.

    6. Credentials: Please make sure to retain copies of credentials of staff delivering covered health-related

    services. We recommend retention of these credentials for five years for audit purposes.

    7. Parental Consent Forms: Remember that parental consent to bill Medicaid is required annually.

    Keep in mind that MSB? is willing to catalogue consent forms for you. Please find a sample consent

    form included in this packet.

8. Attendance Baseline: Please forward your COMPLETED SBRS Baseline to us NO LATER THAN

    Monday, October 5, 2009. Your baseline should include all students in your district with an active IEP.

    Also, in the event of an audit, school attendance records for all children being audited must be available

    for the auditor’s review to demonstrate that the child was present and received covered services.

    9. Reduced Rate: As you know, students who receive IEP-ordered Speech/Language services from a

    Speech Clinician who is not licensed by the State of Maine as a Speech/Language Pathologist must be

    billed at a reduced rate. Each of your students will fall under one of these three categories:

    a. No Speech services given…FULL RATE

    b. Speech services, prescribed on an IEP, given by a licensed Speech/Language

    Pathologist…FULL RATE

    c. Speech services, prescribed on an IEP, given by an unlicensed Speech Clinician…REDUCED

    RATE

    Meeting Descriptions

    For the MaineCare Program

Now that the 2009-2010 School Year is upon us . . .

    What do we need to do to get started?

    As your consulting and billing agent, MSB? would like to make you aware of the meetings that we believe are necessary to successfully launch the new school year. This is especially important to

    those having NEW Special Education Staff. Following is a list of those meetings and respective personnel who should plan to attend:

; Director’s Meeting: 1 Hour

    We’d like an opportunity to sit with you (or your designee) to go over any changes in our forms or

    procedures for the new school year. Regional meetings should suffice, but if you would like an

    individual meeting, please advise us. Your contact person (the person who will be responsible for

    the monthly submissions) is cordially invited to attend this meeting with you. MSB? will

    continue to provide you and your practitioners with sample forms and training we believe

    helpful for state and federal compliance by your school district.

; Regional Training(s): (Optional, but Strongly Encouraged)

    These trainings are held with those service practitioners whose services are included in Maine’s

    “School Based Rehabilitative Services Program.” We recommend all new practitioners attend

    a regional training in the fall. We provide several sessions throughout the day for your

    providers’ convenience. The agenda includes review of regulations as well as proper data entry

    for Medicaid documentation. Registration for these trainings may be completed on www.case-

    e.com/events.

    Field Meeting Request/

    Planning Form

District:

Person to contact

    regarding this meeting:

Position: Tel:

Email Address:

    Type of Meeting Requested

    (please check all that apply)

     Staff training for Medicaid service documentation

Date: Time: Location:

     Reporting visit with an MSB Representative

Date: Time: Location:

     Complimentary internal audit* / comprehensive file review

Date: Time: Location:

    *MSB? complimentary audits are designed to simulate, as closely as possible, an actual audit by either state or federal regulators. Our goal is to provide pertinent feedback that the districts can use to strive for a high level of compliance with Medicaid regulations and to help minimize negative audit findings should there be an actual audit. Should you request a complimentary audit, our specialist will contact you in advance of the meeting to request the needed information to be available on the day of the on-site review.

This form may be mailed directly to the following address:

    MSB?

    97 High Street

    Somersworth, NH 03878

    Attn: Program Specialist

This form may also be faxed to MSB? at (207) 698-9941.