Case Studies

A state educational cooperative serving nearly 300,000 K-12 students across 55 school districts provides therapy services each month to a small subset of students with Individualized Educational Plans (IEPs). More than 1,000 therapists statewide deliver speech therapy services, along with occupational and physical therapy, to special needs students and are eligible to receive Federal reimbursement through Medicaid. For each 15-minute “unit” of therapy, the district receives $1.50 for regular case management and $7 for targeted case management, if the district is able to comply with Medicaid reimbursement requirements.

The Workflow Challenge

In order to file for reimbursement, the Medicaid administrator for one school district was required to manually print 5,000 sheets of paper for individual signatures by up to 55 therapists for each month of billing. Because of these complex reporting requirements, the billing process was often delayed by up to eight months, which significantly increased costs and decreased revenue. Each therapist spent one day per month (or nine days per school year) filling out paperwork at a cost of $50 per hour, which equated to $3,000 per therapist or more than $150,000 per school district per year in paperwork costs for therapy reimbursement.

The HighGear Solution

The HighGear platform was selected to automate the process of tracking speech therapy services and filing for Medicaid reimbursement across four school districts as part of a one-year pilot program. Each step of the process was configured in HighGear, from parental consent, physician authorization and patient progress to therapist notes, advisor notifications and administrator approvals. These processes were built in HighGear by a non-technical program manager over a three-month period, before testing and rolling out the pilot program to an initial group of 100 therapists at the beginning of the 2018-2019 school year.

The Results of Automation

Medicaid reimbursement numbers skyrocketed across the four districts, with therapists now able to track case management services online and quickly provide electronic signatures to simplify reporting requirements. Medicaid administrators were able to quickly export a 300-page electronic report in HighGear each month, instead of printing 5,000 pieces of paper. One district is projected to save $150,000 per year in paperwork costs and reduce paperwork time from 9 days per therapist to 6.5 hours. And the cooperative was able to identify $2.8 million in potential targeted Medicaid reimbursement for an expanded rollout across all 55 districts.