Overview
If you are a Georgia Home Healthcare service provider, then you will need to pay close attention to this article, especially as it pertains to nutritional counseling. The State government is scrutinizing this type of service and the related billing.
Denial Reasons and Corrective Action
For example, if a claim for nutritional counseling has been denied, it is based on policy not being followed.
For all denials, the details are provided in the denial reason:
- Through the monthly denial reports, or
- If you request the denial reasons from me via email
At this point of notification of the denial, in order to get paid for the claim, you should take immediate action to correct it by:
- Reviewing the denial reason
- Reviewing the applicable policy
- Reviewing the incorrect forms that were submitted
Note: The denial statements for the claims also contain more than one rationale as to why the claim is denied.
Documentation Requirements

If not doing so already, the Home Healthcare (HHC) provider will need to begin including the Case Management care path from SOURCE so that the reviewers:
- Know what services the member needs
- Can validate if the Care Plan is sufficient for the services needed for the member
Avoiding Common Pitfalls
In addition, it is important to discontinue submitting updated Care Plans that contain fewer tasks than the original submitted Care Plans.
- If most of the Care Plans are updated after the billed Date of Service (DOS), you will be denied
- If it seems like the HHC is trying to circumvent tasks that have been denied by not including them on the updated Care Plans, it will negate payment
Conclusion
Understanding and adhering to Medicaid policy and documentation requirements is critical to ensure proper reimbursement for services such as nutritional counseling under Georgia’s Home Healthcare program.
Frequently Asked Questions
What is nutritional counseling in Georgia’s Home Healthcare program?
Nutritional counseling involves providing dietary guidance and support as part of a patient’s care plan. In Georgia’s Medicaid Home Healthcare program, it must be documented properly and tied directly to the patient’s care needs to qualify for reimbursement.
Why are claims for nutritional counseling often denied?
Claims are typically denied due to failure to follow Medicaid policy, such as submitting incomplete or incorrect forms, omitting required documentation like the Case Management care path, or updating Care Plans improperly after the Date of Service.
How can I find out the denial reason for a claim?
Denial reasons can be accessed through monthly denial reports or by requesting them via email. These reasons often contain multiple issues that need to be addressed for successful resubmission.
What documentation must be included to avoid denial?
Home Healthcare providers must include the Case Management care path from SOURCE and ensure the Care Plan sufficiently supports the services billed. Missing or insufficient documentation can lead to claim denial.
What should I avoid when updating Care Plans?
Avoid reducing the number of tasks in updated Care Plans or submitting updates after the billed Date of Service. Doing so may be viewed as attempting to bypass denied services, which can result in non-payment.