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Proof Positive!

More Medicaid Eligible Students = More Medicaid Funds.

A few weeks back we reminded everyone that now is the time of year to review your Child Count Roster. I can’t tell you the number of times we’ve performed this free service for our clients and come across significant positive increases in the number of qualified Medicaid eligible students that are being provided services. Each student that we discover who should be on the Fee for Service Eligible List increases the reimbursements our clients receive. This means critical funding is available to ensure students are receiving the important services they need — and can free up funding for other programs and services.

This year, we at R&G, took some time to do an analysis of the impact this review had on our clients. Even we were amazed by the results. In one school district, we increased their Child Count by 346 students — an increase of almost 50% for that school district alone. And yes, that school district already had about 800 students on their Roster. There were 6 school districts that saw an increase of over 200 students in their Roster!

But this isn’t something that falls through the cracks in just big school districts — our biggest increase (by percentage) was for a school district that had just 21 students before our review — we found 11 Medicaid eligible students that have been added to their Roster and are now being claimed for reimbursement — which is an increase of over 50%!

Overall, the average increase across our review this year is an astounding 31%. Increasing the number of students identified as Medicaid Eligible on average by 56 students.

As a long standing provider to Illinois School Districts, we are proud of the positive financial impact we provide for our clients. If your organization is considering changing the service bureau  you use for Medicaid Claiming, please allow R&G to demonstrate our commitment to our School District clients. We will provide this service up front and let you know how many additional Medicaid Eligible students we have found based on your Child Count Roster.

If you would like to see the results for yourself, please click to download the results here.

IEP Required!

I was recently talking with a colleague about the IEP requirement for Medicaid claims. I mentioned that only Medicaid eligible students WITH an IEP can be claimed. He mistakenly thought it was open to all Gen Ed students too. That is not correct!

I want to stress to our clients and all Illinois School Districts that the Fee for Service Program is a Special Education Program. If you are claiming for Medicaid Eligible students who do not have an IEP, you are in violation of the program rules and subject to returning all of the Medicaid funds received. R&G clients know that all claims submitted are for Special Education students only. If you are working with another service bureau, please make sure that you are only submitting for IEP students. As always, if you have any questions about this whether you’re a current client or not, reach out to Holly at 847-933-9030.

IAASE Winter Conference

See you at IAASE Springfield Conference February 20-21

R&G Consultants will once again be a Gold Exhibitor at the IAASE Winter Conference in Springfield. We hope to see many of our clients at the conference and would welcome the opportunity to speak to other District personnel interested in improving their Medicaid claiming.

Please stop by and say hi at our table at the Crown Plaza Conference Center next month.

State delays NPI Reporting

While the State has delayed implementation of the NPI requirement until July 1st, we recommend that all of our clients continue to enter the NPI information for PT, OT, Speech and Audiology services. This information will still be required in the near future. We also want to remind you that all PT and OT records require a current prescription date. Speech and audiology student records require a current referral date.

All always, R&G works with all of our clients to ensure that all required data is correct and ready to be submitted. Please contact Holly at 847-933-9030 if you have any questions about these requirements.

Don’t just rely on your REV Vendor for your Child Count Roster

Now is the time to ensure your Medicaid Eligible list contains all students who are eligible. Don’t just rely on your REV Vendors to complete this critical task.

Are you identifying all of your Medicaid eligible student or simply relying on the results sent by your REV Vendor?

For 30 years, we’ve been dedicated to helping Illinois school districts receive reimbursement for all eligible students. But lately we’ve noticed a number of school districts who are simply relying on the Child Count provided by their REV Vendors. In our experience, these counts are never 100% accurate and often miss a significant number of Medicaid Eligible students – which means those school districts aren’t able to receive the proper reimbursements from the State of Illinois HFS. Additionally, many student records that are returned as Medicaid eligible are not eligible for the School Based Fee for Service Medicaid program.

Need some help?

For years, the team at R&G has been painstakingly investigating each student record that comes back as “Not Found” by the state computer. R&G clients can be assured that due to the extra effort we provide, their Medicaid Eligible list contains the additional eligible records.

In an effort to make sure all school districts in Illinois have accurate information R&G will analyze the results returned to you from your service bureau and let you know if you are submitting claims for students who will not generate any Medicaid funds while missing students who are, in fact, eligible for school based services. Simply contact R&G and submit your Special Education roster. We will evaluate the results and provide a summary of any discrepancy to you.

As always, the team at R&G is dedicated to maximizing your funding through smarter claims for Medicaid reimbursements. If you would like to have us review your Roster, call the office at 847-933-9030.

New Requirement for Reimbursement this January

Were you aware that the Medicaid Director of Illinois has instituted a new requirement for NPI (National Provider Identification) Numbers? This NPI requirement pertains to all Speech, P.T., O.T., and Audiology Services.

Starting on January 1, 2019, to receive your Medicaid reimbursement, the ordering, referring or prescribing practitioner much have a valid NPI number and they must be enrolled through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT). This change was documented in the Provider Notice issued on 11/9/2018. Contact our office if you would like a copy of the notice.

System Update

If you are a client of our Fee-for-Service program, we’ll send you sample referral forms upon your request. In addition, we’ve already updated our software to help you be compliant with this new requirement. When a provider is entering the referring physician, the screen now has a required field for adding the NPI number.


Who’s missing?

In addition to requiring the provider to enter the information when a session is recorded, we’ve also created a new report that will identify which student records still need to be updated.

As always, the team at R&G is dedicated to maximizing your funding through smarter claims for Medicaid reimbursements. If you have any questions about the new requirement or you would like a sample of our referral form, just email Holly at