Medical Billing Companies & Consultants in Brunswick, OH

Healthcare Process Consulting, Inc., known as HPC, is a billing agent and program administrator based in Brunswick, Ohio. It focuses only on public school districts that seek Medicaid reimbursement for health-related services given to special education students.

The firm has announced that it now operates under the Edsana name, which also covers finance ERP products as well as school Medicaid billing. HPC dates back to 1993 and the original Ohio CAFS program. It kept working with districts after that program became the Ohio Medicaid School Program (MSP).

The company reports that it has secured more than $660 million in federal Medicaid reimbursement for its Ohio clients over that time.

Who They Serve

HPC's clients are school districts whose special education departments provide therapy and health services that may qualify for Medicaid. Because medical claims work falls outside normal school administration, HPC takes on the role of the district's MSP coordinator. That leaves special education leaders free to focus on students, and the firm says districts do not need their own internal management or clerical staff to run the program. HPC helps districts claim reimbursement for these service areas:

• Occupational therapy and physical therapy
• Speech/language and audiology services
• Mental health services, including psychology, counseling and social work
• Nursing
• Transportation

Billing and Administration

HPC acts as the district's third party administrator and is the official trading partner with the Ohio Department of Medicaid for claims processing. Its work includes:

• Preparing and submitting billing files each month
• Getting Medicaid recipient numbers for eligible students
• Reconciling claims files every month
• Correcting and resubmitting claims, and reviewing denials
• Reporting paid claims to district treasurers and CFOs

Each client gets an assigned account manager plus a second account staff member. The administrative team serves as the link between the district and the state agencies that oversee the program. Its support covers:

• Managing the Random Moment Time Study (RMTS)
• Training on the ORP referral system
• Auditing claims to catch documentation errors
• Checking provider credentials on an ongoing basis
• Monthly compliance reports
• Support during federal and state audits

Consulting and Financial Services

On the consulting side, HPC trains district staff on MSP rules and helps them respond when state or federal requirements change. It also helps districts start billing for new service categories. On the financial side, HPC leads the required annual Medicaid cost report and the indirect cost report.

It works with the district treasurer and the district's accounting firm on these reports, which affect how much reimbursement a district can receive. The firm also reports on interim payments and reviews cost settlement communications with the state. New clients usually start with a consultation, where HPC estimates the district's realistic reimbursement potential and explains its service model and fees.

Technology

HPC built its own web-based documentation platform, Edu-Doc©, which is now in its third version. It runs on phones, tablets and computers, includes ICD-10-CM and CPT coding, and checks entries for errors so providers can fix problems before claims are lost.

The system builds draft service encounters from each therapist's caseload and schedule, and the company says it produces about three quarters of the claim documentation automatically. It also offers real-time reports on caseloads, referrals, parental consent and provider activity, along with training videos and phone and email support.

HPC describes its team as having 95 combined years of experience across Medicaid school programs, medical billing, finance and software development.