Home Care · EVV & Medicaid

A visit that cannot be verified does not pay.

Home care is paid from the visit record and the authorization behind it. Cardinal BPS lines up the electronic visit, the Medicaid approval, and the claim so a shift that was worked is a shift that is paid.

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The visit has to be verified

Medicaid personal care and home health visits need an electronic visit record: who was served, who provided the care, what service it was, the date, the location, and the time it started and ended. If that record is missing or does not match the claim, the visit does not pay.

The authorization is the limit

Medicaid pays the units that were authorized, for the dates that were authorized, under the code that was authorized. A visit outside that span, or over the allowed units, is a denial even when the care happened.

The state and the plan differ

Each Medicaid program and each managed care plan sets its own visit-verification and billing rules. A clean visit in one program can be a rejected visit in the next. The schedule, the note, and the claim have to follow the payer in front of you.

What we look at

The visit, the approval, and the units on the claim.

Clock-in, clock-out, location, and the six visit details the record has to hold
Caregiver and client identifiers against the authorization
Service code, units, and the dates the authorization actually covers
Manual edits, missed punches, and visits that never made it into the claim
Task notes and the plan of care against what was billed
Eligibility and plan changes before the visit is sent

Where this lives in the work

The schedule, the note, the claim, and the check are one review.

The visit

Electronic visit verification, missed punches, and the match between who worked, who was served, and what was authorized.

Clinical Documentation

The claim

Eligibility, authorization spans, unit limits, and follow-up when a visit is held or denied.

Revenue Cycle Management

The record

Task notes and the plan of care, so the billed service is the service the chart describes.

Clinical Documentation

The check

Visits, units, and notes reviewed together before billing, so a mismatch is caught inside the agency.

Quality Assurance