Press Releases

Spectrum K12 Introduces Medicaid Billing Software to Help Districts Increase Revenue Recovery

New Claims Tracker™ Module for ENCORE! Management System Will Help Districts Maximize Revenue Reimbursement While Eliminating Need for Third-Party Billing Agents

TOWSON, Md. — July 13, 2005 — As school districts across the country clamor for funding, many lose millions of dollars each year simply because they do not file claims for all the services that are reimbursable under Medicaid. While some school districts outsource Medicaid claiming, others attempt to claim internally — often under claiming — or opt to not claim at all. All too often, these situations result in significant revenue losses.

Indeed, according to the book, “Technology for Students with Disabilities: A School Leader’s Resource Guide," published by the National School Boards Association, "In most school districts, because accurate data is lacking, and in an many cases, seriously flawed or non-existent at the time it is required, up to 5% of the child count funding and up to 50% of the Medicaid funding in an educational agency is left on the table, not recovered and not available to the very programs the money was intended to support."

To help districts maximize revenue reimbursement, Spectrum K12 School Solutions Inc. (4GL), the leading provider of comprehensive management solutions for special populations in K-12 education, today announces ENCORE!® Claims Tracker™. An add-on module for the ENCORE! suite of software and service solutions for special populations, Claims Tracker allows districts to perform Medicaid billing internally to maximize revenue recovery while avoiding costly contingency-based consulting fees for third-party billing agents.

Reviews conducted by 4GL of hundreds of school districts show that as much as 50 percent of all billable services fail to be reported. This underreporting translates to lost revenue worth millions to districts. On average, school districts recover 50 percent of Medicaid monies due under their respective state’s service claiming program.

The most significant challenges that impact revenue recovery from Medicaid are often linked to information management. Many districts lack the ability to track the provision of related medical services for special populations, which often results in under-servicing and under-reporting of Medicaid billable services. In addition, many districts employ a paper-driven system that operates outside the special education program. Thus, they often lack the capacity to cross-check provided services against the individualized education plan (IEP) and may bill Medicaid for services without sufficient documentation, which puts them at risk of making inappropriate claims and having to pay back the money.

Claims Tracker optimizes a district’s Medicaid recovery by converting encounter data from ENCORE!, or from another external encounter entry system, into electronic claims that can be automatically transmitted to processing agencies for reimbursement. In addition, Claims Tracker enables districts to use state Health Insurance Portability and Accountability Act (HIPAA) record formats to automatically maintain student Medicaid eligibility information, prepare and submit Medicaid reimbursement claims, and process claims remittance advice.

“Claims Tracker provides school districts with a win-win solution for Medicaid billing. By allowing districts to perform Medicaid billing themselves, it eliminates the need for outside billing agents. For some districts, the annual savings in contingency fees alone can actually pay for the entire ENCORE! product suite within one to two years. For districts that already handle Medicaid recovery themselves, Claims Tracker can help improve efficiency while lowering costs associated with identifying eligibility, and claims filing and processing, which translates into increased revenue,” said Allison Duquette, CEO of 4GL.

To help districts increase data accuracy and efficiency, Claims Tracker automatically applies the correct state rates, codes and rules when generating claims. In addition, it produces a series of financial and management reports to give administrators the data they need to monitor claim submissions, perform financial analysis, monitor remittance advice, and perform claims analysis and investigation. The automated billing application can help districts easily identify denied claims that warrant further investigation, as well as create an audit trail that can be used to defend revenue generated from the billed claims.

Claims Tracker meets standard reporting requirements and the HIPAA guidelines to ensure the confidentiality of information.

About Spectrum K12 School Solutions

Spectrum K12 School Solutions Inc. is the leading provider of comprehensive management solutions for special populations. Building upon its deep expertise in special education, 4GL helps school districts more effectively manage the individualized learning process for all students receiving special services or interventions, including special education, at-risk, Section 504 and Limited English Proficient (LEP) students.

4GL works collaboratively with districts of all sizes to deliver scalable, easy-to-use software solutions that lift the immense burden of paperwork from education professionals so they can focus on the most important part of their work: educating children and improving student achievement. Focused solely on K-12 education, 4GL’s proven, data-driven solutions help districts reduce paperwork, increase efficiency, improve staff morale and retention, increase revenue recovery, eliminate compliance issues, reduce unnecessary referrals to special education, and support successful achievement of individualized education plan (IEP) goals.

Founded in 1996, Spectrum K12 School Solutions is based in Towson, Md. For more information, visit http://www.4glschools.com or call 1-800-490-84GL (8445).