Medicaid Cost Reporting

The Centers for Medicare and Medicaid Services (CMS) has begun implementing significant changes to how Medicaid agencies reimburse health services to school districts that are preformed in adherence with the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program.

Typically, school districts seek reimbursement for certain school health services, such as speech therapy, physical therapy, and occupational therapy, for Medicaid eligible children under a Fee for Service (FFS) billing model. Historically, State Medicaid agencies had considerable flexibility in establishing payment rates for covered health services provided by school districts. However, CMS has recently required a number of states to implement drastic changes to existing reimbursement methodologies in order to implement district-specific and service-specific cost-based reimbursement rates. These requirements are commonly foreign to school districts, as very few understand the intricacies of Medicaid cost reporting requirements. In addition, these changes are consistent with the recent final CMS rule, now delayed until April 2009, that will limit Medicaid reimbursement to public providers to cost.

The inevitable CMS requirements changes will have a significant impact on school districts and their reimbursement levels. School districts will be required to file Medicaid cost reports that will serve as a tool to reconcile Medicaid FFS interim payments with the cost of providing these services.

Expertise PCG Education is one of the few firms in the country that has successfully assisted state Medicaid agencies and school districts to implement new CMS processes.

School districts will need a comprehensive understanding of the new Medicaid reimbursement methodology and cost reporting processes in order to optimize allowable revenue levels. PCG Education has an in depth understanding of OMB Circular A-87, which provides guidance on the permissibility of costs, and has assisted state Medicaid agencies to develop cost reporting forms that successfully capture all of the costs associated with providing health services
in a school setting.

PCG Education has been a critical resource in implementing statistical allocation methodologies to apportion costs reasonably and accurately so that revenue levels to school districts do not suffer.

• Completion of Medicaid cost reporting forms;
• Development of statistical allocation methodologies that optimize the apportioning of costs;
• Support throughout Medicaid audits, plus ongoing cost reporting consulting services.
  

• Louisiana
• Michigan
• Texas
• Colorado

By choosing PCG as your cost reporting and rate setting vendor, you can be assured your Medicaid report will adhere to Medicaid cost reporting regulations and that revenues will be optimized.