Arkansas Medicaid Administrative Claiming (ARMAC) ARMAC Time Study System Coder/Coordinator User s Guide October 2005
ARMAC Overview The Arkansas Medicaid Administrative Claiming (ARMAC) program was instituted to create another reimbursement tool for public education agencies within the state of Arkansas. The program is based on the federal Medicaid Administrative Claiming program overseen by The Centers for Medicaid/Medicaid Services (CMS). The Arkansas Department of Education (ADE) received federal approval from CMS to administer the ARMAC program in spring of 2005. Participation in ARMAC allows public education agencies the opportunity to receive federal reimbursement for Medicaid-related administrative activities. These activities include, but are not limited to: Medicaid outreach; facilitation of a Medicaid application; Medicaid eligibility determination; health-related training; and referral/coordination activities. In order to determine the amount of reimbursement each participating agency will receive, several factors are included in the calculation. First of all, a percentage of time spent on Medicaid-related administrative activities must be determined. This is done through a random moment time study. The ARMAC software randomly selects a point in time paired with a participant. The software then sends an email to the participant, inquiring what they were doing at that selected moment. All of the responses are then collected and a percentage of time spent on Medicaid-related administrative activities is determined. Second, public education agencies are required to submit the salary and other cost data for each participant involved in the time study. The reimbursement for each district is based on the amount of cost the agency incurs for providing these activities. And finally, the ADE, with data collected from Division of Medical Services, will determine the Medicaid eligibility for each public education agency involved. The three components listed above are used to determine the overall reimbursable claim from CMS. Random moment time studies will be completed on a quarterly basis, therefore participating agencies can expect to receive a quarterly reimbursement from CMS. The success of the Arkansas Medicaid Administrative Claiming (ARMAC) program is dependent on the accuracy of data collection, random moment generation, a reliable email system, and report generation. All of these components are included in the ARMAC Time Study System. The following pages contain the necessary steps required for the coder/coordinator to successfully navigate through the ARMAC Time Study System. 2
Getting Started: Upon completion of the ADE in-person training and the ADE software training, each participating district and corresponding coder and coordinator will be added to the ARMAC software database. The coder and coordinator will only have access to the districts assigned to them. Once the ADE has entered the data, an email verification will be sent to each coder and coordinator from the ARMAC Time Study System. The email will contain a unique username and password, which will be used to gain entrance into the ARMAC Time Study System. A link to the application will also be included in the email. Click on the link when you are ready to peruse the system or enter data. For future use, a link to the application will also be available on the Special Education Website (http://arksped.k12.ar.us) under the Medicaid in the Schools section. Once in the Medicaid in the Schools section, look under ARMAC. ***NOTE: All emails sent from the application will come from the following address: ARMACSupport@arkedu.k12.ar.us. If you or anyone has any difficulties with the software, inquiries can be sent to the abovementioned email address. 3
Logging In: When you click on the software link (either from the email or special education website), the following image will appear: Enter the user ID and password assigned to you in the initial email sent from the application. After keying in the ID and password, press Login. When entering the system for the first time, you may be asked to change your password. This password should be individualized for the user and should not be given to anyone else. If for some reason someone obtains your current password, the system allows for the user to change his or her password at anytime. 4
Entering Participant Data For each public education agency enrolled in the ARMAC program, specific participant data must be entered into the system. The district coder is responsible for entering this data into the system. ****Prior to the quarterly time study, a list of dates will be made available to the district coders and coordinators. The list of Important Dates will indicate district data deadlines, as well as other pertinent information. If data are entered after certain deadlines, the data will not be included until the time study in the next quarter. Important Dates will be accessed on the Special Education website or by calling or emailing ARMAC support.**** After logging in successfully to the system, the Moments Screen will appear: When this screen appears, move your curser to the left side of the screen and choose Participants. After choosing Participants, the Participant Screen will appear: 5
Participant Screen and Data Entry When entering the participant data, the coder must first choose the representative district from the pull-down menu. If you are assigned to only one district, there is no need to navigate the pull-down menu. 1. Key in the participant s first name. 2. Key in the participant s last name. 3. Key in the participant s email address. This is the email account that the participant uses for work. The email verified section requires no action from the coder. It is automatically completed to verify the participant s email address. 4. Key in the participant s work phone number. 5. Key in the participant s building number. This is the building in which the participant spends the majority of his or her time. This number is represented by the LEA number followed by the building number. 6. From the pull-down menu, choose the position that best describes the participant. 7. Key in the participant s quarterly Salary Benefits costs expended by the public education agency (see the District Record of Participants worksheet). 8. Key in the participant s quarterly Other Benefits or costs expended by the public education agency (see the District Record of Participants worksheet). 9. The status box will be selected as active by default. If a participant is no longer employed by the agency, you can pull up the district list of participants to deactivate him or her by clicking on the active box. 6
After completing the final step, click Add Participant. This will save the participant data to the district chosen and the following message will appear on the screen: If this message doesn t appear, please check for errors, which will be indicated on the right side of the screen. Once you have correctly entered a participant, you will follow this same format for each participant that has been identified by your agency coordinator. 7
Accessing District Participant List The coder has the ability to access the total number of participants that have been entered into the database. Once the list is complete, the coder can also export the list of participants to an EXCEL spreadsheet for their own records. See the following image for reference: At the bottom of the Participant Screen, the above pull-down menu is available for access by coders with more than one district. To view the list of total participants in a district, the coder simply moves the curser to choose which district they want to access. The list will then appear below the district pull-down menu (see image below): When the need arises to edit the participant data, the coder will access the data using the directions above. Once all participant data are shown, the coder chooses the edit icon at the far left of the participant that requires changes. The current participant data will be shown on the screen. The coder can then navigate through the fields that need edited. After the changes have been made, choose the Edit Participant button to save the new information. 8
Accessing the Moments Screen The first screen that the coder will see after logging into the system is the Moments Screen. The system is designed in this manner, allowing the coder to have the easiest access to all of the individual moments (actual emails sent out to the participants) that have been sent out from the ARMAC Time Study System. The following image is presented when the coder selects the Moments Screen from the menu on the left side of the screen or when logging on to the system. All moments generated by the ARMAC Time Study System fall within five categories: Incomplete, Missing, Rejected, Rejected But Incomplete, or Complete. Coders will use the pull-down menu (as with the Participant Screen) to choose the district; then all of the moments within the selected tab will be displayed. Definitions for moments: Incomplete: All moments within this tab represent the moments that have been answered by the participant and are in need of being coded. Missing: All moments within this tab represent the moments that have been sent out from the ARMAC System, but have not been answered by the participants. Rejected: All moments within this tab represent the moments that have been rejected by the coder and are in need of being re-answered by the participants. Rejected But Incomplete: All moments within this tab represent the moments that have been rejected by the coder, re-answered by the participants, and are in need of being coded. Complete: All moments within the tab represent the moments that have been coded by the coders. They do not require any further action. ****Note**** All moments that are not filed under the Complete tab require followup by the coder. 9
The coder can also access the All Moments tab on the far right of the screen. This will list all of the moments that have been generated within the district and the corresponding status of each (complete, missing, etc.). All tabs on the Moments Screen should be accessed by the coder on a regular basis. As the coder works through the Moments Screen, they can access any individual moment within the tabs. This is simply done by clicking on the time and date of the moment. The moment will then appear making it available for the coder to examine. This will be covered more thoroughly under the Coding Process section of the manual. Automated Email Processes The ARMAC Time Study System has an automated email process designed to serve as a resource and a reminder for coders and participants. For each district that has moments generated, an email is sent in the morning (each day) providing a summary of the day before. Coders will be able to see the moments sent, the total number of moments missing, and the amount that are complete. If no moments were sent to the district that day, the district will not receive an automated email from the system. Participants also receive emails from the system. Participants will be sent a weekly reminder message one week prior to the time study period if they have been selected to participate in the time study. This email doesn t mention times or dates; it just serves as a reminder for the participants to be watchful for emails (moments) within the coming weeks. If the participant is not selected to be in the time study, then they will not receive a weekly reminder message. Participants will also receive a daily email if there are moments that have been sent to them that have not been answered (missing). 10
Coding Process As mentioned above, the Moments Screen allows coders to access all moments that have been sent out to participants. Coders are responsible for making sure the moments get coded in a timely fashion, just like the participants are responsible for answering the moment in a timely manner. Once a moment has been answered by the participant, it will appear under the Incomplete tab on the Moments Screen. The moment is now ready to be coded by the coder. The coder will access the moment by clicking on the underlined time and date (a link). The moment will then appear requiring the coder s attention. See the figure below for a visual example: 11
The coder will view the activity that has been entered by the participant (the response section above). From the response, the coder will assign an activity code to it. This is completed by using the curser to enable the pull-down menu, displaying all available codes. See the example below: Once the moment is completed, the coder will hit the Save Activity button and go on to the next moment to code. The computer will now file this moment under the Completed tab. 12
Rejecting a Response On occasion, coders will find responses from the participants that are not specific enough to code the moment. In these cases, the coder has the option to reject the response. When the coder does this, an email is sent back to the participant with a message from the coder. See the image below: Once the coder has entered the required rejection response, they will push the Reject Response button. This will then send the email back to the participant for clarification. The system will now file the moment under the Rejected tab. Once the participant has re-answered his or her response and saved it, the moment will be filed under the Rejected but Incomplete tab. If the coder needs further clarification from the participant, they will reject the moment following the same steps detailed above. The coder should do this until they receive a response that is sufficient enough to code. Once satisfied with the narrative from the participant, the coder will then assign the response an activity code, and then push the Save Activity button. The system will then file this moment under the Completed tab. 13
Completing the Moment for the Participant On rare occasions, the coder will need to respond to the moment for the participant. Reasons may include: the participant is sick, the participant is no longer in the district, the participant cannot access a computer, etc. When this occurs, the coder will pull up the moment from the tab where the moment is filed. This will typically be under the Missing tab, though it could be filed in another tab on occasion. Once the moment is accessed, the coder will choose a reason (from a pull down menu) indicating the reason they are completing the moment for the participant. Once this is done, they will push the Save Activity button and the moment will be filed under the Complete tab. See the example below: The coder will choose a reason from the list provided in the pull-down menu. If the reason the coder is answering the response is not listed, the coder will need to email ARMAC Support at armacsupport@arkedu.k12.ar.us. Once the reason is entered, the coder will push the Save Activity button and the moment will be filed under the Complete tab. ****Note**** All moments that are not filed under the Complete tab require followup by the coder. Contact Information for ARMAC Support: Email: armacsupport@arkedu.k12.ar.us Phone: (501) 835-2093 ****Please feel free to use the above information for any questions related to the ARMAC program or the ARMAC Time Study System.**** 14
Appendix A Directions for completing the District Documentation Record for Trained Participants 15
Directions for completing the District Documentation Record for Trained Participant The District Documentation Record for Trained Participants is a resource that can be utilized by district coders and coordinators prior to entering the data into the ARMAC Time Study System. In order to meet federal guidelines, the ADE will need to verify that every employee taking part in the ARMAC program has been trained. Page one of the document will be used by the district to keep a list of the total number of participants that have been trained. The method column should either have a P (for In-Person training) or CD (for CD training) for each participant. Prior to generating the moments for the quarterly time study, Medicaid In The Schools (MITS) staff will request a list all trained participants. MITS recommends using this format, however MITS will accept other formats as long as all of the requested data is in place. The second page titled Cost Information is an optional resource that the district can use to accumulate the data to be entered into the ARMAC Time Study System. MITS will not request this form from the district, though the information listed will be required to be entered into the ARMAC system. The purpose of this form is to serve as an organizational resource for districts. See the following directions for completing the Cost Information page: Building: Indicate the building that the participant spends the majority of his or her time. This number will begin with the LEA number and end with the building code. Position: This will correspond with the position code that best represents the participant s position within the district. Salary Cost: Represents the participant's annual salary paid by the district. Other Cost: Represents the participant's annual fringe benefits, travel costs, training costs, materials, supplies paid by the district. Quarterly Salary Cost: This is amount of salary cost that will be entered into the ARMAC Time Study System for the participant. The calculation is the annual salary divided by four. Quarterly Other Cost: This is the amount of other cost that will be entered into the ARMAC Time Study System for the participant. The calculation is the annual other cost divided by four. 16
When entering data for contract staff, the current quarter cost to the district will be entered. Ensure that actual totals entered into the ARMAC Time Study System are accurate. If you require any assistance with this matter, please email or contact ARMAC Support. Prior to the quarterly time study, MITS will be reviewing all of the data entered by the district coders for quality assurance purposes. MITS staff may be in contact with district coders and coordinators in order to clarify all entered data. 17
Appendix B Participant Overview of ARMAC Email System 18
Participant Overview of ARMAC Email System The overall statewide success of the ARMAC program not only depends on the district coders and coordinators, but also all of the participants involved. As a participant in the program you have the responsibility of telling (through a narrative email response) your district coder what you were doing at a point in time. The reason that this information has to be collected is so that the ARMAC Time Study System can determine the amount of time is spent on Medicaid-related administrative activities. The narrative response that you save is automatically sent to a coder in your district, who then establishes (based on your answer), whether or not that activity is an allowable Medicaid administrative activity. Based on the statewide completion and coding of the emails distributed by the ARMAC Time Study System, a statewide participation percentage is calculated. The more responses received, the more statistically significant and relevant the percentages are to the calculation. Participant Email Process After receiving training either by CD or In-Person training, participants are then eligible to be included in the quarterly time study. When the district coder enter you particular data into the ARMAC Time Study System, an email will be sent to your email address. This initial email is sent to verify your email address. Please see the following for an example: Please click on the link to verify your email address. When verified you will see the following message: 19
Once verified, the ARMAC Time Study System recognizes the participant as a possible candidate to be included in the next time study. Prior to the quarterly time study, Medicaid In The Schools (MITS) staff generate the random moments within the system. The moments are paired with participants, which are then assigned to random dates. The system is setup to send out an automated weekly notice email to each participant that has been scheduled for the time study. The email will tell participants that they have been chosen to participate in the upcoming time study, though no specific time or date is given. No action is required for this email, though participants will want to keep in mind that they will be receiving at least one email (possibly more) starting the next week. The Random Moment Notification email that the participant will be receiving looks similar to the following example: The participant is to click on the link. At that time, the following will image will appear requiring the participant to enter what he or she was doing at that specific point in time: 20
After completing the narrative, the participant will push the Save Response button. This completes the process for that particular moment and the following image will appear: This process will be repeated for each moment that the participant receives throughout the quarterly time study. Rejected Moments The ARMAC Time Study System allows the district coder the ability to request more information from the participant for an individual moment. When this occurs, the coder will reject the moment that was saved by the participant. An email will then be sent to the participant with a message from the coder explaining what he or she needs clarified. Once the participant completes the additional information requested, the Save Response button is pushed. The coder will then code the moment, unless further information is needed, which will be acquired with another rejection to the participant. We encourage the participant to be specific when answering the initial narrative response in order to decrease the amount of moments needing clarification. 21