Home Healthcare Medicaid Denials

Home Healthcare Medicaid Denials
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.
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 (either 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, policy and the incorrect forms that were submitted.  The denial statements for the claims also contain more than one rationale as to why the claim is denied.
If not doing so already, the HHC will need to begin including the Case Management care path from SOURCE so that the reviewers know what services the member needs and can validate if the Care plan is sufficient for the services needed for the member.
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 DOS, you will be denied.  If tt 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.
 
Home Healthcare Medicaid Denials