District examines MaineCare billing options but flags audit and paperwork risks

The board heard a detailed presentation on MaineCare billing and possible program expansions from Cat Cox, the district’s director of instructional support.

Cox said the district currently bills for occupational, speech and physical therapy through an outside billing agency and that parental consent is required before the district can submit claims. "We need consent to bill for any of those things," Cox said, adding that the district does not see who is MaineCare-eligible (the outside agency handles eligibility) for privacy and compliance reasons.

Cox outlined two areas the district could explore: billing for in-district day treatment (more integrated behavioral health services) and school psychological evaluations. She warned that both carry regulatory hurdles and significantly increased paperwork and staffing needs. "There is a very high risk of audit," Cox said, noting that other districts have faced audit repayments amounting to "hundreds of thousands of dollars" when billing paperwork or processes were incorrect.

Board members asked whether other districts operate in-district day treatment, whether the agency handling billing is performing satisfactorily and how many parents decline consent. Cox said she would research examples, gather consent-rate data from the office and report back. The board discussed credentialing requirements for billable providers (for example, that speech billing generally requires a pathologist rather than a clinician) and the operational implications of adding treatment programs.