Quarterly MAC Financial Data Submission Training Presented to: West - - PDF document

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Quarterly MAC Financial Data Submission Training

Presented to: West Virginia Association of School Business Officials Presented by: Public Consulting Group, Inc. October 18, 2012

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Outline

• Medicaid and WV Medicaid Administrative Claiming (MAC)
• MAC Participation Requirements
• Claiming Allowable Costs
• Calculating the Claim
• Web-Based Reporting System (Medicaid Cost Reporting and

Claiming System—MCRCS)

• Quarterly Financial Submission
• Second Quarter Pilot RMTS Results
• Important Dates and Contact Information

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Medicaid and WV Medicaid Administrative Claiming (MAC)

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Schools and Medicaid

• Schools provide an array of health-related (medical) services in addition to

traditional “educational services” to ensure that students are able to fully participate in the school environment.

• These direct medical services form the basis for the West Virginia

Department of Health and Human Resources, Bureau for Medical Services (DHHR/BMS) Medicaid Fee-for-Service (FFS) program.

• School staff are uniquely positioned to assist in enrollment of eligible

students in Medicaid, to assist them in receiving the medical services and supporting administrative services they require, and to provide medically- necessary services .

• These administrative services form the basis for Medicaid

Administrative Claiming (MAC).

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What is the Medicaid Administrative Claiming Program?

• The Medicaid Administrative Claiming (MAC) Program offers reimbursement

for the costs of the administrative activities, such as outreach, that support the DHHR/BMS program.

• These activities fall into several categories:
• Medicaid Outreach
• Facilitating Medicaid Eligibility Determination
• Transportation Related to Medicaid Services
• Translation Related to Medicaid Services
• Program Planning, Policy Development, and Interagency Coordination

Related to Medicaid Services

• Medicaid-Related Training
• Referral, Coordination and Monitoring of Medicaid Services

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Claiming Allowable Costs

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Allowable Costs

• Only costs incurred by providers are allowable
• Report only those costs associated with specific individuals

participating in the RMTS program (i.e. how much does it cost to employ each staff person)

• Allowable Costs
• Salaries
• Benefits
• Materials & Supplies
• Travel & Training
• Contracted Staff Costs
• Dues & Fees

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Allowable Costs

• Allowable Costs
• Salaries
• Include all costs paid (gross) to the participant including any

additional compensation

• Employee Benefits
• Include all benefits paid to staff. Some examples include
• Dental Insurance
• Health and Accident Insurance
• Life Insurance
• Long-term Disability Insurance
• FICA
• Medicare
• Tuition Reimbursement
• Worker’s Compensation
• Teachers Retirement or Other Retirement Payments

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Allowable Costs

• Materials & Supplies
• Materials & Supplies must be identified as used by the staff for

which they are included

• Materials & Supplies can be identified using a “reasonable

allocation method”

• Some methods include – headcount or FTE
• Please do not include any other costs used by direct medical

service providers to deliver services to each individual student. Report direct medical other costs when the Medicaid Cost Report is available for submission in Fall 2013.

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Allowable Costs

• Staff Travel
• Costs for specific staff related to travel for trainings
• Examples include:
• Mileage to trainings
• Conference related travel expenses
• Staff Professional Dues and Fees
• Report by service the total costs for professional dues and fees

associated with the staff listed in the Quarterly Financial Report.

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Allowable Costs

• Pending final approval, CMS has requested that costs be reported

using the cash and accrual basis. PCG requires quarterly costs be submitted using the cash basis method of accounting for quarterly expenditure reporting and accrual for annual cost reporting.

• Cost reporting by providers should be consistent with generally

accepted accounting principles (GAAP), which are those principles approved by the American Institute of Certified Public Accountants (AICPA).

• Reported costs in this section should be formatted with two decimal

places and not rounded to the nearest whole dollar.

• Reported paid hours should be formatted with two decimal places and

not rounded to the nearest whole hour.

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Non-Allowable Costs

• Non-allowable costs include:
• Federal funds
• The web-based system requires that total costs be reported,

with a separate column for reporting costs paid with Federal

• funds. The system calculates the Medicaid-allowable costs.
• State flow-through funds are funds received from the Federal

government by the State of West Virginia and then distributed to Local Education Agencies (LEA)

• Non-federal funds that have been committed as local match for
• ther Federal or State funds or programs
• Costs included in the calculation of the Unrestricted Indirect Cost

Rate

• Staff who are paid entirely from this area should not be

included in the staff pool list.

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Calculating the Claim

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Calculating the Claim

• The main components used to calculate a claim:
• Random Moment Time Study Results (State)
• Quarterly Expenditure Data (District)
• Medicaid Eligibility Rates—MER (District)
• Unrestricted Indirect Cost Rates—ICR (District)
• Federal Financial Participation—FFP (State)
• The claim is calculated by distributing the allowable costs and

applying the above factors.

• It is simple addition, subtraction, multiplication, and division.

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Calculating the MAC Claim

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Calculating the Claim through the Random Moment Time Study (RMTS)

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General Administration Overhead Factor Calculation

• General Administration Code
• Example Calculation
• Codes 1,2, and 3 are Reimbursable
• Code 3 is reduced by the MER
• Code 4 is Non-reimbursable
• Code 5 is the General Admin. Code for this example
• MER = 20%

C o d e 1 2 3 4 5 T o ta l 8 .6 1 % 1 0 .2 5 % 9 .4 3 % 5 3 .2 8 % 1 8 .4 4 % 1 0 0 % T im e S t u d y P e r c e n t a g e

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General Administration Overhead Factor Calculation

• Reimbursable %
• Numerator (Sum of Reimbursable Time) =
• Code 1 + Code 2 + (Code 3 X MER)
• 9% + 10% + (9% X 20%) = 20.74%
• Denominator =
• 100% less General Administration
• Note: Non-worked / Non-paid is not included
• Code 1 + Code 2 + Code 3 + Code 4
• 100% - 18.44% = 81.56%
• General Administrative Overhead Factor
• = 21% / 82% = 25.43%

C o d e 1 2 3 4 5 T o ta l 8 .6 1 % 1 0 .2 5 % 9 .4 3 % 5 3 .2 8 % 1 8 .4 4 % 1 0 0 % T im e S t u d y P e r c e n t a g e

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Calculating the Claim

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Web-Based Reporting System

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Web-based Financial Reporting System Demonstration

• Accessing the System
• Navigating the System
• Downloading Reporting Format
• Uploading Data
• Resolving System Audits
• Certifying the Data
• Managing Contacts

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Getting Started

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Logging In

• To access the Medicaid Cost Reporting and Claiming System (MCRCS),
• pen an internet browser and enter: https://costreporting.pcgus.com
• The username is the submitted email address. Passwords will be sent to

LEAs via email. Once logged in, the site users will be prompted to reset the password. If passwords are forgotten, simply click on ‘Forgot Password’ Link and a correct response to a security question will prompt the system to send a password to the user.

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Dashboard

• Once logged in, the Dashboard displays.

From this page it is possible to navigate through the screens. Also displayed are important dates, training information, and resources. Please check this page at every log in.

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Contacts

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System Contact Types

• The web-based reporting system has three levels of access for LEA staff:
• 1. District Administrators
• Required to “manage” the LEA’s contacts (or web-based system

users) by adding, deleting, or editing contact information. The District Level Administrator includes the role of Report Editor and can add, delete, or edit information in the web-based system. The District Admin is the only user type that can certify the quarterly financial submission.

• 2. Report Editor
• An LEA contact with the role of Report Editor can add, delete, or

edit information in the web-based system.

• 3. Report Viewer
• An LEA contact with the role of Report Viewer can only view

information in the web-based system and cannot add, delete, or edit information.

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Managing Contacts

• Please update contact information after logging in the first time.

Select ‘Manage Contacts’ from the menu bar. Select the ‘edit user info for the district’ link to update contact information.

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Managing Contacts

• The ‘District Admin’ for the LEA will need to add any users to the system

that require access to submit data or receive related correspondence. To add users, use the ‘Create New User’ hyperlink located at the top of the ‘Manage Contacts’ section of the application. After all the information has been entered, click ‘Create User’.

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Managing Contacts

• The contact types, Report Editor and Report Viewer, will only be able to edit

their own information in the site. Select ‘Manage Contacts’ from the menu

• bar. Scroll down until you reach your contact information in the list, select

‘Edit User Info For This District’. Enter the updated information and select ‘Save Changes’.

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Managing Contacts

• Contacts must be entered and maintained by the LEAs.
• LEAs must have at least one District Admin contact type.
• We suggest at least two active contacts to be listed within the
• system. This will help the LEA receive future communication on the

Quarterly Financial Submissions for MAC and the yearly Medicaid Cost Report for School Based Health Services (SBHS).

• Accurate phone numbers and emails will help us provide information

to you.

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Quarterly Financials

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Quarterly Financial Submission

• LEAs will submit their financial information on a quarterly basis via the

Medicaid Cost Reporting and Claiming System (MCRCS)

• Select the ‘Quarterly Financial Submission’ tab from the Dashboard, the

following menu will appear:

• Select Quarterly Payroll Information to begin entering costs

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Quarterly Payroll Information

• The system has been pre-populated with information from the Random

Moment Time Study (RMTS) staff pool lists:

• First and last name
• Staff employment status
• RMTS job category
• LEA job title
• Each quarterly submission requires the reporting of payroll costs for staff

listed (or who replaced someone listed) on the staff pool lists for the applicable period, as well as staff travel/training costs and professional dues/fees.

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Quarterly Payroll Information

• Contacts can enter financial information directly in the site or download to

an Excel spreadsheet, enter the financial information, and upload.

• Screen shot of pre-populated form, description of columns to follow.

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Quarterly Payroll Information

• Description of fields within the system
• Staff Employment Status: An LEA may edit this field to notate a full-

time, part-time, or contractor employee.

• Job Category: An LEA may not edit this field. If changes are required,

please contact PCG.

• LEA Employee ID: This field is not required and is for the use of the
• district. Do not report Social Security numbers in this field.
• LEA Job Title: This field is not required and is for the use of the LEA.
• Payroll Information includes: Paid hours, Full-Time Equivalent,

Salary, Retirement, Social Security, Life insurance, Health insurance, Other employee insurance, Other employee benefit, Contracted staff costs, and Compensation federal revenues.

• Federal compensation should be entered in the system as a positive

number, it will be subtracted from the gross total of payroll information to show a net amount that will be used in the claim

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Importing and Exporting Data

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Importing and Exporting Data

• To expedite the data submission process, a LEA can organize their data in a

spreadsheet using an application such as Microsoft Excel™, then they can upload their information in a comma separated values (CSV) file.

• At the bottom of various pages, including the Quarterly Payroll Information

Page, there are import/export buttons

• Your first step will be to export the template from the system by clicking
• Export. The user will be prompted to click another Export button in order to

export the file as a CSV, which is the only available option. The system will then ask the user to Open or Save the file. It is suggested that the file be saved to the desktop so that it can be found easily for upload. Once the user has saved the template file, please open it in a spreadsheet application, such as Microsoft Excel™

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Importing and Exporting Data

• The LEA District Coordinator can now enter in the LEA salary and benefit

information into the spreadsheet. Please do not format any of the cells to currency or date. For all currency, please enter in decimals only without currency symbols or commas.

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Importing and Exporting Data

• Once the editing of the template is complete, save the file in the exact same

format as it was upon exporting it, CSV. Once saved, return to the page for importing the data and click Browse. Select the CSV file that you have just updated on the desktop. Notice that the path to the file then displays in the field to the left of the Browse button. Click Import.

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Importing and Exporting Data

• If the system detects no errors in the data, it will upload it to the system
• immediately. If there are errors, they will be circled in red on the top of the
• page. All errors must be corrected before the system will allow further

upload of any data.

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Quarterly Payroll Information

• It is extremely important to make sure the entry for payroll is

accurate from quarter to quarter.

• At the end of the year, the system will add the quarterly payroll

information and summarize the costs for the yearly Medicaid Cost Report.

• If there are changes that need to be made at the end of the year, the

quarterly MAC claim will also need to be recalculated.

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Quarterly Other Costs

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Quarterly Other Costs

• Other Costs include: travel & training, professional dues & fees, and

materials & supplies. They are entered in a separate sheet as a total rather than individual items.

• Select the ‘Quarterly Other Costs’ link from the Quarterly Financial

Submission menu .

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Quarterly Other Costs

• Service Types
• The eight (8) FFS service categories and MAC Services are listed

(Audiology and Speech-Language Pathology Services; Occupational Therapy Services; Physical Therapy Services; Psychological Services; Nursing Services, Personal Care, Care Coordination, and Health Needs Assessment and Treatment Planning) on MCRCS. These are the Medicaid service types that can be delivered by the staff listed in the Quarterly Financial Submission.

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Quarterly Other Costs

• Quarterly Other Costs Descriptions
• Materials and Supplies/Materials and Supplies Paid with Federal Funds.
• Materials & Supplies must be identified as used by the staff for which

they are included.

• Staff Travel and Training Costs/Staff Travel and Training Costs Paid with

Federal Funds

• Travel associated with performing Medicaid reimbursable activities.
• Additional training for staff associated with performing Medicaid

reimbursable activities.

• Staff Professional Dues and Fees/Staff Professional Dues and Fees

Paid with Federal Funds.

• Memberships with professional organizations.
• Licensure fees.

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Quarterly Other Costs

• The clinician categories where your LEA has staff will be visible on

this page. It is for these groups that LEAs can enter costs.

• Enter the costs as positive numbers.
• Enter any federal funds as positive numbers. The sum of all federal

funds will be subtracted to show a net total.

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Edit Checks

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Quarterly Edit Checks

• Select the ‘Quarterly Edits link from the Quarterly Financial Submission

menu to view/correct/refute errors

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Edit Checks

• Edit Checks are items the system identifies as possible errors. In order to

certify the quarterly financial submission, errors need to be corrected or an explanation as to why it is not an error entered in the system.

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Edit Checks

• There are 3 levels of edit checks in the system
• Level 1: Will not allow you to save the information when entering

directly into the system. An error message will appear, describing the error and how to correct it.

• Level 2: An edit that is outside what we would expect. The

system will allow an explanation to be entered and saved.

• Level 3: The system will not allow this type of entry in the
• system. It must be corrected before certification occurs.

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Common Errors

• Once information has been entered, the web-based system analyzes the

reported payroll information and reviews it for common errors. Examples of common errors include:

• Reporting salaries or contracted compensation in excess of $25,000 for

a quarter.

• Reporting employees benefits in excess of 65% of reported employee

salaries.

• Reporting more federal funding for a staff person than the amount of

reported payroll costs for that staff person.

• If a common error is identified, the provider must make necessary revisions

to resolve the issue or provide a written explanation as to why the reported information is accurate.

• PCG will follow-up with each provider if the explanation does not clearly

describe why the costs are higher/lower than expected.

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Certifying Quarterly Financial Submission

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Quarterly Certification

• Select

the ‘Quarterly Certification’ link from the Quarterly Financial Submission menu to certify costs

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Certifying Quarterly Financial Submission

• Verify your financial summary information is calculated correctly and click

‘Certify Quarterly Financial Submission’ when complete.

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Certifying Quarterly Financial Submission

• The status symbol will change from Yellow (in progress) to Green (certified).

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Quarterly Certification

• Once the edits/reviews have been resolved or explained, the web-based

system generates a quarterly cost report from the reported information.

• The LEA then certifies the quarterly cost report data and if there are no
• utstanding errors then it automatically transmits the financial

submission.

• After the quarterly costs have been submitted, the system is locked so

no further changes can be made to that quarterly financial report.

• If changes are required after submission, the LEA District Coordinator

must contact PCG to have the system unlocked. Once the system is unlocked, the LEA can make the necessary changes, certify the revised data, and electronically submit the revised financial submission.

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Certification of Public Expenditures Forms

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Certification of Public Expenditures (CPE) Forms

• After the conclusion of the submission period for the quarter, PCG

will conduct a final review and check of the data.

• Once the final Quality Check is complete, PCG will generate the

CPE forms and send them to the LEAs.

• The LEAs must complete and sign the CPE form and return it to

PCG via the instructions by the due date.

• If the CPE form is not received by the due date, the Quarterly MAC

Claim will not be calculated.

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Second Quarter Pilot Random Moment Time Study Results

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RMTS Pilot Results

Pilot Q1 (2‐15 to 3‐31) Pilot Q2 (4‐1 to 6‐30) Direct Service 92.13% 89.25% Personal Care 78.60% 78.05% Case Management 83.20% 82.40% Admin 89.47% 89.25% Response Rate

• Target Response Rate is 85%

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RMTS Pilot Results – Direct Service

Code Activity Indicator # Moments % Activity % after Reallocation 1.a Non‐Medicaid Outreach U 0.00% 0.00% 1.b Medicaid Outreach TM/50% 0.00% 0.00% 2.a Facilitating Non‐Medicaid Eligibility U 0.00% 0.00% 2.b Facilitating Medicaid Eligibility Determination TM/50% 0.00% 0.00% 3 School Related & Educational Activities U 318 17.47% 20.42% 4.a Direct Medical Services – Not Covered as IDEA/IEP Service U 210 11.54% 13.49% 4.b Direct Medical Services – Covered as IDEA/IEP Service IEP Ratio 698 38.35% 44.83% 5.a Transportation Non‐Medicaid U 0.00% 0.00% 5.b Medicaid Transportation PM/50% 0.00% 0.00% 6.a Non‐Medicaid Translation U 0.00% 0.00% 6.b Medicaid Translation PM/75% 2 0.11% 0.13% 7.a Program Planning, Development and Interagency Coordination U 1 0.05% 0.06% 7.b Program Planning, Development and Interagency Coordination PM/50% 6 0.33% 0.39% 8.a Non‐Medical/Non‐Medicaid related Training U 10 0.55% 0.64% 8.b Medical/Medicaid related Training PM/50% 0.00% 0.00% 9.a Referral, Coordination, and Monitoring Non‐Medicaid Services U 14 0.77% 0.90% 9.b Referral, Coordination, and Monitoring of Medicaid Services PM/50% 215 11.81% 13.81% 10 General Administration R 263 14.45% 0.00% 11 Not Paid/Not Worked U 83 4.56% 5.33% Invalid U 0.00% 0.00% 100.00% 100.00% Total Moments 1820 Response Rate 91.00% West Virginia ASBO Conference

RMTS Pilot Results – Personal Care

Code Activity Indicator # Moments % Activity % after Reallocation 1.a Non‐Medicaid Outreach U 0.00% 0.00% 1.b Medicaid Outreach TM/50% 0.00% 0.00% 2.a Facilitating Non‐Medicaid Eligibility U 0.00% 0.00% 2.b Facilitating Medicaid Eligibility Determination TM/50% 0.00% 0.00% 3 School Related & Educational Activities U 1027 65.79% 75.07% 4.a Direct Medical Services – Not Covered as IDEA/IEP Service U 52 3.33% 3.80% 4.b Direct Medical Services – Covered as IDEA/IEP Service IEP 224 14.35% 16.37% 5.a Transportation Non‐Medicaid U 0.00% 0.00% 5.b Medicaid Transportation PM/50% 0.00% 0.00% 6.a Non‐Medicaid Translation U 0.00% 0.00% 6.b Medicaid Translation PM/75% 0.00% 0.00% 7.a Program Planning, Development and Interagency Coordination U 0.00% 0.00% 7.b Program Planning, Development and Interagency Coordination PM/50% 0.00% 0.00% 8.a Non‐Medical/Non‐Medicaid related Training U 0.00% 0.00% 8.b Medical/Medicaid related Training PM/50% 0.00% 0.00% 9.a Referral, Coordination, and Monitoring Non‐Medicaid Services U 0.00% 0.00% 9.b Referral, Coordination, and Monitoring of Medicaid Services PM/50% 11 0.70% 0.80% 10 General Administration R 193 12.36% 0.00% 11 Not Paid/Not Worked U 54 3.46% 3.95% Invalid U 0.00% 0.00% 100.00% 100.00% Total Moments 1561 Response Rate 78.05%

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RMTS Pilot Results – Case Management

Code Activity Indicator # Moments % Activity % after Reallocation 1.a Non‐Medicaid Outreach U 0.00% 0.00% 1.b Medicaid Outreach TM/50% 0.00% 0.00% 2.a Facilitating Non‐Medicaid Eligibility U 0.00% 0.00% 2.b Facilitating Medicaid Eligibility Determination TM/50% 0.00% 0.00% 3 School Related & Educational Activities U 1215 73.73% 84.61% 4.a Direct Medical Services – Not Covered as IDEA/IEP Service U 19 1.15% 1.32% 4.b Direct Medical Services – Covered as IDEA/IEP Service IEP Ratio 71 4.31% 4.94% 5.a Transportation Non‐Medicaid U 0.00% 0.00% 5.b Medicaid Transportation PM/50% 0.00% 0.00% 6.a Non‐Medicaid Translation U 0.00% 0.00% 6.b Medicaid Translation PM/75% 0.00% 0.00% 7.a Program Planning, Development and Interagency Coordination U 0.00% 0.00% 7.b Program Planning, Development and Interagency Coordination PM/50% 0.00% 0.00% 8.a Non‐Medical/Non‐Medicaid related Training U 8 0.49% 0.56% 8.b Medical/Medicaid related Training PM/50% 5 0.30% 0.35% 9.a Referral, Coordination, and Monitoring Non‐Medicaid Services U 42 2.55% 2.92% 9.b Referral, Coordination, and Monitoring of Medicaid Services PM/50% 31 1.88% 2.16% 10 General Administration R 212 12.86% 0.00% 11 Not Paid/Not Worked U 45 2.73% 3.13% Invalid U 0.00% 0.00% 100.00% 100.00% Total Moments 1648 Response Rate 82.40%

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RMTS Pilot Results – Admin

Code Activity Indicator # Moments % Activity % after Reallocation 1.a Non‐Medicaid Outreach U 0.00% 0.00% 1.b Medicaid Outreach TM/50% 0.00% 0.00% 2.a Facilitating Non‐Medicaid Eligibility U 0.00% 0.00% 2.b Facilitating Medicaid Eligibility Determination TM/50% 7 0.39% 0.54% 3 School Related & Educational Activities U 1126 63.08% 87.63% 4.a Direct Medical Services – Not Covered as IDEA/IEP Service U 5 0.28% 0.39% 4.b Direct Medical Services – Covered as IDEA/IEP Service IEP 23 1.29% 1.79% 5.a Transportation Non‐Medicaid U 0.00% 0.00% 5.b Medicaid Transportation PM/50% 0.00% 0.00% 6.a Non‐Medicaid Translation U 1 0.06% 0.08% 6.b Medicaid Translation PM/75% 1 0.06% 0.08% 7.a Program Planning, Development and Interagency Coordination U 7 0.39% 0.54% 7.b Program Planning, Development and Interagency Coordination PM/50% 1 0.06% 0.08% 8.a Non‐Medical/Non‐Medicaid related Training U 16 0.90% 1.25% 8.b Medical/Medicaid related Training PM/50% 2 0.11% 0.16% 9.a Referral, Coordination, and Monitoring Non‐Medicaid Services U 4 0.22% 0.31% 9.b Referral, Coordination, and Monitoring of Medicaid Services PM/50% 55 3.08% 4.28% 10 General Administration R 500 28.01% 0.00% 11 Not Paid/Not Worked U 37 2.07% 2.88% Invalid U 0.00% 0.00% 100.00% 100.00% Total Moments 1785 Response Rate 89.25%

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Important Dates and Contact Information

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Important Dates for MAC

• First Quarterly MAC Submission
• Due February 15, 2013
• First Annual Cost Report
• Due December 31, 2013

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Contacts

Public Consulting Group WVSBHS@pcgus.com 1-877-908-1745

Joseph Weber Lauren Rodrigues Leslie Tremberth Kenneth Cheung Katherine Deptula Jonathan Fortier

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