“When we got the recoupment demand, we thought seriously about closing our doors – how could we fight the State? SembraCare got us on the right track in fighting the recoupment and helped save us an enormous amount of money. And we’re still here.” Philip Morris, Home Choice Healthcare
Your Home Health Care Agency won’t stay in business if you can’t get paid! DMA’s site has a new “how to get paid” guide, located at http://www.ncdhhs.gov/dma/provider/URVendorInstruct.pdf . This guide makes a few points that are worth going over:
First, it is imperative to get your clients ready for letters from DMA or CCME which cut their hours. They should know that they will have only ten days to get their appeal filed, and that your home health care agency will help them get this done pronto – no delay! If the appeal isn’t filed in the ten day window, your clients’ right to keep their hours stops until the appeal is received. This can cost you a lot!
Second, don’t let your client file their own appeal, especially without your home health care agency being named as representative! Why so? Simple: clients will be confused and intimidated and will not know what to say without you; CCME won’t give you key hearing dates, so your staff will not play a role; DMA will keep the result of the appeal a secret from you; and you will pay the aide but DMA won’t pay you.
Third, DMA has finally set some standards which CCME and other vendors will have to meet in handling appeal cases. CCME must get the Maintenance of Service authorization completed within five business days from their receipt of the appeal. So, keep your fax transmit report, to prove when the appeal was sent!
This posting adds to the advice in October 2010 Basic Medicaid Billing Guide, found on DMA’s site at:
You can visit this page often for some tips but imagine the information you get if you’re our customer. At SembraCare, our expertise and tech tools max your money while you work on building and maintaining your home health client base. We scour the web for the info you need, and we break it down here, http://www.sembranet.us/category/latest-news/, saving you time and headaches.
On October 29, 2010 North Carolina Division of Medical Assistance published two new proposed Clinical Coverage Policies for In Home Care Adults (IHCA) and In Home Care Children (IHCC), which are intended to replace the existing PCS/PCS Plus program. DMA is looking to close down the existing PCS and PCS Plus programs as soon as possible after January 1, 2011. The new replacement Policies have a 45 day comment period.
The most important aspect of the new proposed policies would be the change in the minimum requirements for PCS eligibility. Under current Policy 3C, a recipient must have two ADLs assessed as needing at least limited assistance. Under the proposed new IHCA policy, recipients must have at a minimum two ADLs, of which one must be at least rated as needing extensive assistance, or a minimum of three ADLs rated as needing at least limited assistance.
The new policies may be accessed here: http://www.ncdhhs.gov/dma/mpproposed/index.htm