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Medicaid Changes Policy
Requiring Plan of Care
Documentation with Claim
Submission
The Iowa Medicaid Enterprise (IME)
will be announcing in the next week
a long-anticipated significant
change in the claims submission
process for home health agency
providers. Effective
January 1, 2009 Medicaid home health
agencies will no
longer
be required
to submit copies of home health
service case notes and plans of care
for each Medicaid member. This
change in the claims submission
process applies to all services
provided by Medicaid home health
agencies. Submission of paper
case notes and plans of care for all
Medicaid claims will be replaced by
a new ‘post-pay’ Quality Review
process described below.
Elimination of this paper
documentation requirement offers
Medicaid home health providers the
opportunity to fully benefit from
the ease and accuracy of electronic
claim submission. This was the
final barrier that kept many Home
Health Agencies from moving more
completely to Electronic Media
Claims (EMC). With this change
in policy IME is encouraging home
health providers to file claims
electronically.
Preparing for
Electronic Claims Submission
Electronic billing of home health
claims will require enrollment with
EDISS and installment of PC-ACE
software or other compatible billing
software. If your agency is not
currently billing electronically,
PC-ACE billing software is available
to Iowa Medicaid providers without
cost.
IME Provider Services will be
providing outreach and training to
assist home health agencies with the
electronic billing process and
implementation. These outreach and
training activities will be outlined
in a forthcoming informational
letter.
Home Health Services Quality Review
The January 1, 2009 date also marks
the implementation of a revised
quality review of home health
services offered through the
Medicaid State Plan home health
benefit. Note: This quality
review does not include reviewing
claims for the prior authorized
services through the Care For Kids (EPSDT)
program, which will continue with
its existing review processes.
These services are Private Duty
Nursing and Personal Cares.
Iowa DHS Informational Letter
No. 758 (see link below) includes an
overview of this quality review
process.
Additional Information:
Posted: October 8, 2008
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