Chicago Public Schools (CPS)

Fee For Service (FFS) Medicaid Recovery

In FY 1999, CPS commenced implementation of a significant operational improvement initiative called ChildServe. The main goals of ChildServe were to move toward a datadriven management process, resulting in increased service documentation, increased compliance, improved efficiency for clinicians, and increased Medicaid fee-for-service reimbursement (to offset impending decreases in administrative outreach claiming). ChildServe required the monumental transition from documenting health services on paper logs to electronic documentation using laptop computers, and ultimately using this information for a data-driven form of management. The full transition took approximately nine months, and PCG Education facilitated the transition while, at the same time, intensifying normal operations to ensure maximum FFS claiming for the year.

Some states establish school-based billing programs that include unnecessary barriers and/or restrictions to Medicaid reimbursement for school districts. PCG Education maintains the legal expertise to help identify unnecessary barriers and/or restrictions and to successfully coordinate with the appropriate state agencies, in conjunction with our clients, to remove them. In working with Chicago Public Schools, PCG Education was able to facilitate statewide regulatory changes for the removal of group size limitations and physician referral requirements consistent with State law. Steps included:

• Transitioning the project from a prior vendor in a 60-day period with no interruption of cash flow to CPS;
  
• Coordinating efforts with the Department of Healthcare and Family Services (HFS) (formerly Illinois Department of Public Aid) to enhance identification of Medicaid eligible students;
  
• Conducting extensive research to identify barriers to Medicaid/SCHIP enrollment encountered by the CPS population;
  
• Creating comprehensive training programs, including oral presentation seminars and training packets designed specifically for clinicians and other school personnel involved in FFS compliance;
  
• Developing customized FFS service documentation forms compatible with scanner technology to capture all therapeutic services provided and complete billing data;
  
• Facilitating the transition from paper to electronic documentation without any gap in the flow of revenue to CPS;
  
• Developing management reports to compare required IEP services to the services actually delivered.

• $217 Million in federal Medicaid FFS funds recouped since project inception;
• Transitioned 1,600 staff from paper to electronic data capturing in a 9 month period;
• IEP service documentation compliance increased by approximately 20 percent in the school year following implementation of electronic documentation.