Local education agencies (LEAs) are continuously looking for ways that they can improve the health and wellbeing of their students; one of these ways is reimbursements made by the school-based Medicaid program. For the children who are eligible for the Medicaid program (low-income children,) education agencies can claim back the cost of medical services and some of the costs of administrative activities that come within the Medicaid program. This will mean that educational establishments will be able to expand and access many useful resources for their health services, which will have many benefits for the students involved. School-Based Medicaid Claiming

School-based health services are vital when it comes to dealing with a variety of health issues that some children suffer from, from anxiety, problems with hearing and vision, to dental hygiene. Having issues such as these can prevent children from making positive progress within their education and even have long term effects on their health. Children who have access to health providers at school tend to have better attendance at school, and their health and academic performance become exponentially better. Access to health providers has a positive impact on children’s future as well as their present. This is why it is important for educational services to make use of the school-based Medicaid program by expanding their school health services to include things that can be reimbursed by school-based Medicaid.

Who is eligible for Medicaid?

Medicaid is a program that provides health coverage to low-income Americans. Some of the mandatory groups that the program covers include low-income families, people receiving Supplemental Security Income (SSI), and qualified pregnant women and children. There are many more mandatory groups, and some of them vary from state to state. School-Based Medicaid Claiming

As well as financial eligibility, there are also some non-financial eligibility criteria that Medicaid beneficiaries have to meet. These include being a citizen of the US or a qualified non-citizen. Recipients must also live in the state where they receive Medicaid. There are also some other eligibility criteria that must be met. 

If you think a child may be eligible for Medicaid, but you are not sure, it can be better to put in an application and potentially get some coverage than not apply and miss out.

How are Medicaid payments made available to school providers?

Schools have to provide a range of medical services for children so they can get the most out of their education. If a child is eligible for Medicaid, they will pay for many of these services. To receive Medicaid funding, eligible children must be enrolled in the program, if they aren’t school can help them to enroll. Medicaid can help children with disabilities receive the help that will allow them to do their best in education, but it will also ensure other eligible children receive things like hearing, vision, and dental screenings so that nothing hinders their learning.

For reimbursement Medicaid payments to be made, the school providing health care services must determine a cost for each service made available. They also need to collect third party insurance details (Medicaid and non-Medicaid) from all those who access a service, and make sure that other third party insurers are billed. 

Some health services and their associated administrative costs cannot be billed to Medicaid. This includes any services available to all students for free or if another third party is legally liable to pay for and provide the service.

Administration work for Medicaid

There is a lot of administration work that goes into school-based Medicaid claiming, that is why you can also claim for administrative costs. Essential claim data and information need to be compiled thoroughly so that there are no problems with any claims being approved. When the right information is provided, it will ensure that the costs for all the Medicaid eligible children can be claimed via Medicaid. If there are any problems and a claim is denied, you will also have all the information necessary to work the denied claims.

Some of the administrative work that will need completing is looking at student and provider eligibility, cost reporting, administrative cost reporting, random moment time study (RMTS) monitoring, training, and many other things. The time study is crucial as it is one of the main ways of showing the methodology behind administrative costs for reimbursements. Without it and additional information about administrative activities, the cost of those administrative activities may not be appropriately reimbursed by Medicaid. It can sound complicated, but with the help of New England Medical Billing, it doesn’t have to be.


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