In general, there are two approaches to how to bill home care time: Rounding and “truncating.”
In many state Medicaid programs and most private duty companies, visits are rounded to the nearest interval (most commonly to the nearest 15 minutes but sometimes rounding to the half-hour or even to the hour). In other cases however you can only bill for “complete units of service.”
In Missouri, for example, you can only bill “complete 15 minute units” so if your caregiver works 59 minutes you can only bill 45. In Virginia Medicaid, you can only bill completed hours. This creates a hardship because in most cases labor laws require you to pay caregivers for all of their minutes even if you can’t bill for them.
If your agency or state lets you round to the nearest 15 minutes, then the rest of this post isn’t really for you… but if you can only bill completed units or completed full hours, read on:
Bill Complete Hours and Roll-Over Additional Minutes
As mentioned above, one of the Virginia Medicaid rules is that you can only bill complete hours, and in the era of EVV, if the caregiver is there for 2 hours and 55 minutes you can’t just round up. Similarly in Missouri Medicaid home care (billed to EMOMED) you can only bill complete 15 minute units so if the caregiver works 59 minutes you can only bill 45. The good news is that you can keep track of those unbilled minutes and combine them with extra minutes from other days and bill them when you accumulate an additional hour (VA) or unit (MO).
Here are some rules and examples:
- This only applies when it’s the same caregiver and same service
- It has to be within the month
- Here’s a Virginia example (based on hours):
- Monday: Caregiver works 2 hours and 43 minutes. You bill 2 hours and hold onto the 43
- Wednesday they work 3 hours and 4 minutes. You bill 3 hours and hold onto the 4 minutes. Now you’re up to 47
- Friday: Caregiver works 2 hours and 15 minutes. You can bill the 2 complete hours from today, but you also now have an accumulated 62 minutes so you can bill an extra hour.
Why is this important to my agency (regardless of my state)
As always, my hope is that this tip is useful to you. If you have any questions, or tricky billing scenarios that you’d like us to discuss, or other tips to share please comment on this post or reach out to us.For help with your EVV implementation, please feel free to click here!
This article was provided by Ken Accardi from Ankota: Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us
Kenyon Homecare Consulting Can Help:
Kenyon Homecare Consulting focuses on helping agencies provide high quality care. We help agencies with clinical issues, education, operations and marketing. Our senior associates come from a diverse background to work with a team approach to help you succeed. Call us at 206-721-5091 or contact us online to see how we can work for you.