The Missouri Medicaid program is administered by EMOMED, which stands for Electronic Missouri Medicaid. Like all Managed Care Medicaid programs, EMOMED strives to make sure that your claims are clean before reimbursing you so your first goal is to clean up your data. If you're new to Medicaid home care please read this article about clean claims.
When Ankota starts working with a Medicaid home care provider, we often find that a significant percentage of their claims aren't getting paid and they don't even know it or know how to track down those missing payments. For that reason, a lot of our posts focus on the basics of effectively managing a Medicaid Home Care agency.
But once an agency gets those basics under control, they're ready to learn more advanced techniques (often state specific) for maximizing their payments from the state Medicaid program. This article explores some of those advanced techniques for Missouri Home Care providers.
3 Ways to Maximize Home Care Reimbursement with EMOMED
- Accrued Minutes: Pretty much all states pay for home care in 15 minute "units" and since not all visits are an exact multiple of 15 minutes, there is some type of "rounding rule" to determine what can be charged. A lot of states use the rule that you should round down where there are 7 or fewer minutes and round up when there are 8 or more minutes.
- Missouri's rule is different. In Missouri Medicaid, you can only charge for completed 15 minute units of care. If for example, a caregiver is supposed to work for an hour and they instead work for 59 minutes, you can only bill for 45 minutes. The good news, however, is that you can accumulate or accrue those 14 minutes and combine them with other accumulated minutes to bill them later.
- Continuing the above example, if the caregiver works 59 minutes on a Monday, you can only charge 45, but then if they work 63 minutes the next day, you can combine the 3 accumulated minutes from the next visit with the 14 from the previous day for a total of 17 minutes. Then you can take 15 of those minutes and bill an additional unit (and you can continue to accrue the additional 2 minutes).
- Although this math isn't hard, it's best handled by software and many of the software programs don't have the ability to bill for these. Billing accrued minutes will likely increase your billing by two hours (8 units or ~ $32 per client per month).
- Spreading Unused Units Across Remaining Days: EMOMED authorizes units on a monthly basis and since most months have 31 days, they authorize based on a 31 day month. But 5 of the 12 months have fewer than 31 days. April, June, September and November have 30 days each and February has 28 (or 29 in a Leap Year). The second advanced technique is to take the additional units and spread them across the remaining days.
- So, if a client is authorized for 7 days of care and they're authorized for 248 units of care per month (2 hours a day), then in a 30 day month, there will be 8 units of authorized care that won't be scheduled unless you deliberately ensure that they are. A best practice in this regard is to have your software automatically schedule these additional units for you. Following the example above, you can have your software schedule one additional unit per day for the first 8 days of the month.
- Allow CDS Essential Transportation to be completed on any day: If you're experienced with Cyber Access Plans of Care, you've likely noticed that the authorized units work out to a perfectly rounded visit time per day. Taking the example above, 248 units per month on a 7 day a week case comes out to a perfect 2 hours per day (in a 31 day month). For many Consumer Directed Services (CDS) clients they are also authorized some additional units for "Essential Transportation." This provides for transportation services (to doctor's appointments, the grocery, etc.). Generally these hours are allocated on a weekly basis (like 8 units or 2 hours per week). While it's logical to allocate transportation on a weekly basis, it's hard to schedule.
- Some agencies try the approach of asking their consumer what day or days they want to have their transportation service. Even if the consumer gives an answer, the reality is that they're going to want their transportation when they need it (the day that they have a doctors appointment or need to stock up on groceries).
- An alternative approach used by some agencies is to spread the transportation units among the regular CDS visits that are scheduled over the course of the month, so in the above example, instead of scheduling 2 hours per day, they schedule 2 hours and 15 minutes per day and have the caregiver indicate when they provide transportation. This benefits the consumer by giving them ultimate flexibility in scheduling their transportation and it helps the caregiver and the agency to deliver the maximum authorized care.
The techniques described above are somewhat advanced and the one paragraph explanations are unlikely to be enough information for you to master the concepts and deploy them in your agency. If you'd like to learn more, please contact Ankota so we can give you more detail and help you bring these best practices into your agency.
If you'd like to learn more about managing Medicaid Home Care businesses, please download our free e-Book "Best Practices for Success in Managed Care Medicaid Home Care" by clicking the link below:
Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us.
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