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A Pediatric Perspective

Medicaid Billing in School Based Practice

Published August 24, 2012 4:47 PM by Cecilia Cruse

Last week I had the great pleasure of giving a guest in-service for a team of school based OTs and PTs as part of a series of meetings during their back to school planning days.   The speaker before me gave a review on this school system's Medicaid billing process. This got me wondering so after he left, I posed a series of questions to the group regarding their policies.  Yes they have been billing for several years now, yes they can bill for group therapy services, and yes the school district feels that the added administrative costs for billing Medicaid are worth it (some of the reimbursement actually goes to help fund equipment purchases in their therapy dept.).  As my barrage of questions to them continued I found out that No, they cannot bill for on behalf time (not working with the student directly but working on assistive technology for example) and No none of these therapists felt pressure to let the reimbursement drive the provision of  their therapy services. They assured me that they were clear on when they could and could not bill for services and were being encouraged to use best practice in their implementation.  This school system and their strong team of therapists seems to have found the balance between practical reimbursement procedures and successful provision of school based therapy services.

Back in 2000, Charlotte Royeen et all published a brief report in the July/August edition of AJOT entitled "Effects of Billing Medicaid for Occupational Therapy Services in the Schools: A Pilot Study."   They used a 9 item question survey that 200 OT's completed.  At that time, therapists that participated in the study voiced multiple concerns including feeling forced to follow a medical model approach to school based practice to ensure that services were reimbursed and that the additional paperwork and billing requirements for reimbursement cut into time previously spent with the student and/or in collaboration with other special ed team members.    I can't seem to find any literature to support any follow up studies, so I am conducting my own informal survey.  If you are a school therapist, let me know if you think the Medicaid model for billing has improved and/or is being used successfully (or not!) in your system.  If you don't want to comment on my blog, then just email me at ccruseot@aol.com.   I look forward to your input. 

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