Home » Blog Articles » Waiver Providers » Advice For Ohio Medicaid Waiver Providers and Other I-DD Agencies

Helping individuals with developmental disabilities is the driving focus for I-DD agencies both large and small. Yet, finding and keeping skilled direct support professionals (DSPs) is a challenge for many Medicaid Waiver providers and human service agencies.

Beyond the challenge of maintaining proper staff levels, agencies have the pressure of staying in compliance, maintaining schedules and staying aware of other billing and regulatory requirements. In fact, these managerial and billing challenges are enough to drive some waiver providers out of the I-DD industry.

For many years Advanced Billing & Consulting Services (ABCS) has delivered experienced billing and software solutions for Ohio provider agencies. During this time, they have identified a few key concepts or best practices for organizations that provide support services to individuals with developmental disabilities.

Here is some general advice that all waiver provider agencies should adhere to when providing services:

[1] Properly Documenting Hours:

Many industry observers would agree that direct support professionals (DSPs) are overworked and underpaid. In order to make their working environment easier, agencies should have a reliable system that documents the hours that they have worked. Staff members should not have to keep track of the hours they have worked on separate pieces of paper. This is tedious and cumbersome in the long run.

DSPs want to quickly see what hours they are scheduled to work. They also want to have a direct way to communicate questions or requests for shift changes to their supervisor. This task is made easier by using modern workforce management software that has been specifically designed for Waiver providers who work with the I-DD community.

By the very nature of their work, DSPs have a challenging job. Figuring out procedure codes, billing units, maintaining compliance and calculating hours worked should not present additional challenges. Ideally, any workforce management solution that is used should readily integrate with other systems in your office.

[2] Keep All Staff Members Healthy:

DSPs and other caregivers can easily suffer from burnout and physical ailments. Due to the demanding nature of their work, caregivers need to find ways to stay healthy and lower their stress levels.

One of the easiest ways for DSPs to stay healthy is for them to not skip meals. One people skip meals, they will actually have less energy in the long run. It is important that people eat at least three healthy meals a day. Saying that they do not have time to eat is not an excuse.

Getting some regular physical exercise also helps, no matter how minor. Every little bit helps. In general, any employee should not work without taking proper breaks. Work breaks are actually great times for workers to fit some lite exercise into their daily routine.

Last, but not least, all staff members should get between 7 to 9 hours of sleep. Sleep deprivation is a growing problem in the United States. When people do not get enough sleep, their immune system breaks down and becomes compromised; individuals become more susceptible to diseases.

[3] The Limits of Electronic Visit Verification (EVV):

Medicaid Waiver providers deliver services which can seem simple to some outside observers, however these services are deceptively complex. This same concept applies to the federally mandated use of Electronic Visit Verification (EVV) by all Medicaid Waiver providers and home care agencies.

EVV sounds simple enough. When DSPs provide services, a telephone and/or computer-based system will electronically verify that these services actually took place at the appropriate time and location. However, in reality, problems may occur when trying to implement and manage EVV systems.

A major concern is that EVV time stamps (punches) may not fully match the hours that the employee has worked. For example, a DSP may show up for their assigned shift on time, but a situation was occurring that required their full attention. They may not have a chance to log into the EVV system until 30 minutes or more has passed. Issues can appear when comparing self-documented, assigned and EVV-documented time.

Electronic Visit Verification EVV is one more tool in a Medicaid Waiver provider’s toolbox. However, it is not perfect. I-DD agencies and other care providers will still need to keep accurate and detailed records.

Other General Guidelines For Medicaid Waiver Providers: Visit Verification (EVV):

The Centers for Medicare and Medicaid Services remind waiver provides that their internal documentation must support proof of services delivered in order to bill for these services. Successful waiver provider agencies should integrate the following practices into their daily routines: quality control on all Medicaid-funded services, maintain accurate beneficiary records and claims processing and ensure that all services are delivered in a timely manner.

As a general rule, I-DD agencies should adhere to these four general rules:

  • Make sure the person-centered plan, assessments or reassessments, and physician orders, if required, are current and included in the beneficiary record.
  • Make sure all staff members are qualified and authorized to perform these services.
  • Make sure documentation is complete, supports services billed, and reflects beneficiary attendance on the date of service if services are provided in another venue.
  • Make sure that all procedure codes, billing units, and calculation of units are correct.

Every U.S. state is a little different in the way that they administer and monitor the Federal Medicaid Waiver program. For example, here is some general advice for new Medicaid Waiver providers in the state of Ohio. The Ohio Department of Developmental Disabilities (DODD) requires that both individuals and agencies are certified by the state, before providing any service to people with developmental disabilities.

About Us:

Advanced Billing & Consulting Services (ABCS) provides a variety of administrative services for healthcare professionals. Their eWebSchedule software solution is a package of tools specifically designed for the unique administrative needs of Ohio Waiver Provider Agencies that deliver support for individuals with developmental disabilities.

Our suite of tools is just one of the many services offered by ABCS RCM. We deliver a variety of solutions for healthcare professionals, including account management & billing services for waiver provider agencies.

As a company with a long history in Ohio, ABCS has a proven track record of results. We provide services and tools that optimize a provider agency’s administrative and billing processes. As an Ohio-based company, we are familiar with the unique needs and challenges facing waiver provider agencies.

Whether your agency offers adult-day array, non-medical transport, ICF/DD (group homes), supported living or institutional respite – we can help.

Contact ABCS RCM for more information at 614.890.9822.

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