Helping individuals with developmental disabilities is the driving focus for I-DD agencies both large and small. Yet, f
Beyond the challenge of maintaining a proper staff levels, agencies have the pressure of staying in compliance, maintaining schedules and staying aware of other billing and regulatory requirements. In fact, these managerial and billing challenges are enough to drive some Waiver
providers out of the I-DD industry.
At eWebSchedule, here is some general advice that we give all of our clients:
 Properly Documenting Hours:
Last, but not least, all staff members should get between 7 to 9 hours of sleep. Sleep deprivation is a growing problem in the United States. When people do not get enough sleep, their immune system breaks becomes compromised and individuals become more susceptible to diseases.
 The limits of Electronic Visit Verification (EVV):
Medicaid Waiver providers deliver services which seem simple to an outside observer, but are really deceptively complex. This same concept applies to the Federally mandated use of EVV by all Medicaid Waiver providers and home care agencies.
EVV sounds simple enough. When DSPs provide services, a telephone and/or computer-based system will electronically verify that these services actually took place at the appropriate time and location. However, in reality problems may occur when trying to implement and manage EVV systems.
A major concern is that EVV time stamps (punches) may not fully match the hours that the employee has worked. For example, a DSP may show up for their assigned shift on time, but a situation was occurring that required their full attention. They may not have a chance to log into the EVV system until 30 minutes or more has passed. Issues can appear when comparing self-documented, assigned and EVV-documented time.
Electronic Visit Verification EVV is one more tool in a Medicaid Waiver provider’s toolbox. However, it is not perfect. I-DD agencies and other care providers will still need to keep accurate and detailed records.
Other General Guidelines for Medicaid Waiver Providers:
The Centers for Medicare and Medicaid Services remind waiver provides that their internal documentation must support proof of services delivered in order to bill for these services. Successful waiver provider agencies should integrate the following practices into their daily routines: quality control on all Medicaid-funded services, maintain accurate beneficiary records and claims processing and ensure that all services are delivered in a timely manner.
As a general rule, I-DD agencies should adhere to these four general rules:
- Make sure the person-centered plan, assessments or reassessments, and physician orders, if required, are current and included in the beneficiary record.
- Make sure all staff members are qualified and authorized to perform these services.
- Make sure documentation is complete, supports services billed, and reflects beneficiary attendance on the date of service if services are provided in another venue.
- Make sure that all procedure codes, billing units, and calculation of units are correct.
Every U.S. state is a little different in regards as to how they administer and monitor the Federal Medicaid Waiver program. Here is a helpful link with the Medicaid Waiver contact information for all 50 U.S. states.
For example, here is some general advice for new Medicaid Waiver providers in the state of Ohio. The Ohio Department of Developmental Disabilities (DODD) requires that both individuals and agencies are certified by the state, before providing any service to people with developmental disabilities.
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