- The first step is verifying that the patient is Medicaid eligible.
- Verify their share of cost (client portion of fiscal responsibility)
- Obtain the payment effective dates.
- On the SEO referral, area on aging assessment you will find the payment effective date(s)
- Ensure that the census is correct.
- Care level reports to determine the level of care.
- Facility Medicaid rate sheets.
- Help with yearly weighted days report
- Reconciling census with Medicaid records
Medicaid Billing Adjustments
If the claim is denied or payed incorrectly we start the Medicaid billing adjustment process electronically. If improper wording is used or too vague the adjustments must be resubmitted. Most people don’t track the adjustments especially if it is done by paper and not electronically. We usually see less than 1% of claims needing adjustments after the on-boarding process for our clients. But our staff can help with past Medicaid billing within 90 days. After 6 months the money is not collectable.