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Medicaid Billing Integration

The HealthOffice® Anywhere nursing services application makes accurate Medicaid billing documentation extremely easy and it maximizes school revenues. The Medicaid revenue produced by school nurses more than pays for the software. It should also provide substantial additional revenue to help pay the salaries of school nurses or provide funds for other nursing department needs.

Once activated, the billing module offers complete control of the billing process:

Medicaid Billing Integration screenshot

Using the integrated Medicaid documentation functionality, medical diagnosis, procedure codes, and other required information can be recorded, generally automatically, by the use of templates, as a part of documenting each encounter.

The Billing Template is Integrated Into Every Event

Billing Template screenshot

An Example of Some Office Visit Billing Templates

List of Office Visit Billing Templates screenshot

An Office Visit with Integrated Billing Template

Office Visit Billing Template example screenshot

The Medicaid documentation functionality provides the ability to record the specific ICD-9/10 code at the time any scheduled nursing, special education, or mental/behavioral health procedure is initially set up. When the scheduled (or prn) medication is dispensed or the scheduled procedure is documented, the correct ICD-9/10 is automatically recorded in the documentation, providing accurate entries and saving hours of coding time; whether or not a template is used.

Office Visit Billing Template example screenshot – entering information

All of the state-specific billing procedure codes and modifiers for each job classification are recorded as part of the initial configuration, and the software automatically restricts use of specific codes to each billing provider to her/his specific job position.

Office Visit Billing Template example screenshot – entering more information
Office Visit Billing Template example screenshot – entering even more information

The system provides the ability to record the professional license(s), including expiration dates, and qualifications of each user, and notifies the user and her/his supervisor prior to license expiration.

Professional license(s) screenshot

The Medicaid billing integrated system will not submit a Medicaid claim for a provider needing a supervisor's review of the documentation unless the approval is documented and attached as part of the event record.

Medicaid billing pre-approvals screenshot

Prior to transfer of billing information to Healthmaster's Medicaid claim processing service, the program verifies that the particular school was in session on that day and, as part of a future enhancement, will compare the date of each recorded service with the student's attendance records to better ensure the accuracy of each claim for purposes of submission and audit. At the present time, the system will not allow a claim to be submitted for any scheduled event where the student has been recorded as absent.

The HealthOffice® Anywhere billing functionality provides assurance, as much as possible, that:

  • a specific professional
  • with a valid, current license
  • provided specific, documented services
  • authorized for that professional to provide
  • to a specific student
  • on a specific day that the school was in session
  • where the student was in attendance
  • recording a valid ICD-9/10 code
  • recording a Medicaid procedure code authorized to be used by that professional
  • containing, when necessary, a supervisor's approval and authorization.