Shore Educational Collaborative

Billing Services

Shore Educational Collaborative serves as a Medicaid billing provider for twelve school districts for the three phases of Medicaid Reimbursement.

Direct Care Medical Services (Fee for Service)
Administrative Activity Claims (AAC)
Annual Cost Report

Direct Care Medical Services (Fee for Service)

  • All Medicaid eligible SPED students that have direct care medical services identified on their IEP, and have parent Authorization, are eligible to be billed, providing the therapist providing the service meets the Medicaid definition for his/her position.
  • Authorization letters are prepared by Shore and mailed along with a stamped, self-addressed envelope to parents and guardians.
  • The Medicaid biller works directly with the therapist to identify their caseload of students. When the Medicaid biller identifies the Medicaid eligible students, they are placed on our ShoreDoc program for each therapist to record the documentation. This process is continued throughout the school year.
  • The ShoreDoc program is an online documentation program that was developed by Shore. It allows the therapist to document their services online, as opposed to creating written documentation and mailing to the Medicaid biller. The therapist has the ability to record the documentation at their leisure, anytime as long as they have access to a computer and internet. The program allows the therapist to review their caseload at anytime, as well as print the completed documentation for their records. The utilization of ShoreDoc has worked well and eliminates the SPED office from having to provide this information directly to the biller.
  • The Medicaid biller keeps the SPED office updated on the progress of the monthly documentation by alerting them if any of the therapists have not completed their documentation. This practice helps to maximize the Medicaid reimbursement to their school district.
  • The billing is processed on a monthly basis and submitted to Mass Health. A spreadsheet of all billings is kept by student by month.
  • Each year, all the documentation is stored on a CD to be used in the event of an audit, thus cutting down on the mounds of paper that would ordinarily be necessary.

Administrative Activity Claims (AAC)

  • Each quarter, an AAC claim is prepared. The AAC claim consists of school personnel that participate in either providing the direct care medical services or assisting in the gathering of pertinent information used for the billing.
  • The information includes salary and fringe benefit costs, specialized transportation expenditures, capital costs, and Chapter 766 private school and other tuition expenditures paid in the quarter.
  • Both the total school Medicaid eligible student percentage factor and the SPED Medicaid eligibility percentage factor are used in the calculation of the reimbursement.
  • In order for the school district to process and submit the quarterly claim, all the school personnel listed in the claim must participate in the Random Moment Time Study (RMTS).
  • Before each quarter, the school district must provide an RMTS template to School-Based Medicaid including the name, employee number, email address, job position, full-time equivalency, percentage of salary that is federally funded, and whether or not the employee provides medical services to students.
  • From that list, School-Based Medicaid will randomly select employees to participate in the quarterly time study. As a contact for the RMTS, Shore monitors the participation and reports back to the SPED office. Reminder emails are sent both to the participant and Shore if the moment has not been completed. Shore then forwards the emails to the participant and urges them to comply. Emails are also copied to the Sped office.
  • Once the AAC claim is completed, it is uploaded for approval. When it is approved, a Certification Form is complete and sent to the school district to be signed and dated, then submitted to School-Based Medicaid.

Annual Cost Report

  • The annual cost report provides additional Medicaid reimbursement monies to supplement the direct care medical services reimbursement.
  • All the personnel listed in the Job Code 1 of the quarterly AAC claim (including all the therapists, counselors, Medicaid billers, etc.) have been loaded from the quarterly AAC claims that includes salary information.
  • On the AAC claims, the Chapter 766 private school expenditures are reported in total, however, on the Annual Cost Report the annual tuition for each Chapter 766 private school is recorded individually by school code.
  • The Medicaid percentage of the totals is calculated by determining the total number of SPED students that receive direct care medical services and the number of students that are actually billed.
  • The annual cost report must be completed on line and submitted by Dec. 31st. A certification form is printed with the gross amount due to the school district. However, the net amount is not recorded at this time. School-Based Medicaid determines the net amount, subtracts the interim payments made during the year, and the balance is paid to the school district.

In addition to our full range of Medicaid billing services, Shore will contract for the use of our ShoreDoc program. One Collaborative, with 18 school districts, is currently using ShoreDoc and we have received excellent feedback from this Collaborative regarding the time-saving benefits.

For more information, please call Maryann Lucia, Medicaid Adminstrator, at 617-370-6350 or email her at mlucia@shorecollaborative.org