When any kind of mistakes are made on School-Based Medicaid Claiming forms, it will always result in a delay of the payment, or payment in error and eventual recoupments. Whether the insurance carrier is Medicaid or any other carrier this puts your organization at risk. Most of these mistakes will be caught by the carrier because carriers specifically look for such errors, whether they be unintentional mistakes or outright attempts at fraud.

Any claims which are denied on the basis of errors will be returned to the claimant, who must correct and re-submit them. In the meantime, precious time will have been wasted and the claimant will not be paid for services rendered. When a claimant has a significant number of claim denials, it can result in having a great deal of revenue tied up, and not being issued as expected. Needless to say, this can cause some considerable financial discomfort to a claimant, because it has a major impact on cash flow.

Clearly, it is to your advantage to carefully review all school-based Medicaid claiming claims before submitting them, so as to minimize any claim denials and maintain positive cash flow. Here are some of the most frequent errors made when submitting claims for school-based Medicaid claims. By studying and remembering these, you might be able to avoid committing these same errors yourself, and you can then save yourself a lot of time and lost revenue by being paid in a timely manner through the Medicaid program.

Unbundling of codes 

There are quite a few procedures which can adequately be expressed on a claim using a single code or single service line with multiple units, and the single codes should be used whenever it is possible, for the sake of conciseness. When you attempt to break down the service provided into several other codes (unbundling), this might be out of ignorance, or it might be an attempt to receive greater reimbursement. Whatever the reason, this is a practice which should be avoided, and instead the single code should be used wherever appropriate to cover the claim for the complete procedure, and not its component parts. Check out our cheat sheet for commonly used ICD-10 codes here for more information.

Overbilling 

When a student receives a 10-minute examination but the billing claim is for a 60-minute session, this is a classic example of over-billing. It’s also a fraudulent activity, which could result in your school being excluded from the Medicaid program entirely, when audits are conducted. There have been numerous cases in the past which have been well documented, and which involved this kind of misrepresentation of the actual facts in a claim. Of course, this can be difficult to prove and that’s why the practice is as widespread as it is. But if you are caught over-billing, you can expect to pay a substantial fine at the very least. School-Based Medicaid Claiming

Inaccurate reporting of injection codes 

Whenever students are given injections of any kind, it should be reported and claimed using a single code which covers the whole session. In quite a few cases however, multiple codes have been used to express the claim, and that will result in a denial of claim every single time. These kinds of claims are considered to be improper reporting, and they will never be honored by the carrier, so it’s not worth making the attempt to use multiple codes when injections are administered.

Improper coding of Telehealth sessions

A great many mistakes are made claiming reimbursement for Telehealth sessions, probably due to the relative new-ness of the practice, and lack of experience in making such claims. First of all, a specific description of the Telehealth service must be included in the documentation so that the proper billing code can be used, and the entire claim must be specified as a Telehealth service. It must also be detailed what kind of Telehealth service was involved, for instance whether the session was between a provider and the student, the provider and a specific school classroom, or between the school classroom and the student’s home.

There are specific documentation steps that should be followed when billing for Telehealth sessions. They are as follows…

  1. Document each Telehealth service in the Activity Note Section in addition to your Activity Note, that includes a brief description of the service provided.
  2. Required: Add the phrase Telehealth from (insert location of clinician) to (insert location of the student).
    • Examples include:
      • Telehealth from ABC Middle School to student’s home
      • Telehealth from provider’s home to student’s home
      • Telehealth from ABC Middle School provider’s office to XYZ Elementary School Classroom 1.

Before billing any Telehealth Service we strongly recommend watching the How to Enter Telehealth Service Video. It goes into detail about the specific coding needed for efficient billing in this area. To watch it, click here and select the How To Enter Telehealth Services video

Did you know, you can now search for all ICD-10 codes right in SimpleNote.  On the left hand side under Provider click ICD Codes. Search for the terminology of the diagnosis or sign/symptom in the Description box to find the corresponding ICD-10 code options.

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