Recent Operational Efficiency & Effectiveness Projects:

Medicaid Maximization at Illinois School District

Increasing Medicaid Revenues

Afton helps school district improve annual Medicaid Fee-For-Service revenues by $700,000 (162% increase) and found $500,000 of one-time, past revenue to recapture.

Public schools throughout America provide medical services to students who need these services to get an education.  These services are written into students’ individualized education plans (IEPs), and school districts receive Medicaid reimbursement for these services when they are provided to Medicaid-eligible children.

Afton recently helped a school district that had seen its share of Medicaid fee-for-service revenues drop by 50% over 15 years even though the number of eligible students increased.  With budgets tightening every year, maximizing reimbursements was essential to ensuring the District was doing all it could to provide the best possible education for its students.

Increasing these revenues proved challenging for district personnel. Over two dozen services are eligible for reimbursement, and the rules and procedures for each can vary drastically. With the District’s staff focused on its primary goal—educating students—there was little bandwidth leftover to overcome administrative hurdles and perform the analytical work necessary to increase reimbursements.

That’s where Afton came in. Afton dedicated a team focused entirely on the specialized task of maximizing the District’s fee-for-service revenues. We provided the District with a partner for communicating with the State and 3rd party vendors and ran analyses on IEPs, billings, collections and service logs to improve the District’s revenues. By the end of the process, Afton uncovered over $500,000 of past claims that had not yet been reimbursed. In addition, by examining the District’s billing and logging data, Afton identified an additional $700,000 of annual fee-for-service revenue that the District could claim. Finally, Afton provided a comprehensive list of recommended business process improvements that the District could implement to retain those additional annual revenues on a recurring basis.

Our Insights

Maximizing Medicaid revenues is both a financial and special education exercise.  Often, school district finance personnel view Medicaid billing as a special education responsibility – because the data required for reimbursement comes specifically from special education staff.  And special education staff are often not trained in financial exercises such as claiming, billing and financial compliance.  Afton’s services bridge this gap to ensure these revenues are maximized.

There are few opportunities to increase revenues in school districts, but Medicaid is an area of significant opportunity. Most school funding is tied to metrics beyond district leadership’s control (i.e. state budgets). The Medicaid reimbursement process is one that often lacks focus within a school district and thus represents an area that, with some focus, can be a bigger source of funding.

Administration is spread thin. One of the first areas where a District cuts manpower is in the central office; fewer full-time staff take on more responsibilities across a wider array of departments. As capacity declines so does the ability for the district to dedicate resources to solving complex issues. A specialized team focused on a specific task can handle intense workloads more efficiently than an already over-worked staff.

Stats & Impact

$430,000

Prior year fee-for-service revenue

$500,000

One-time, immediate revenue recapture

$700,000 (+162%)

Incremental annual fee-for-service revenue