WHAT IS “AT YOUR FINGERTIPS”? “At Your Fingertips” is a monthly tip sheet to help providers navigate Electronic Visit Verification (EVV) by answering common questions and providing assistance for resolving common issues encountered by providers in EVV TIP # 34 their use of the EVV system. WHAT IS THE MEDICAID WEEK? This tip will help you understand the Medicaid week, which is Sunday through Saturday, and why it The Connecticut Department of Social Services defines a week, as used in section is suggested providers bill 17b-262-724 to section 17b-262-735, inclusive, of the Regulations of Connecticut according to the Medicaid State Agencies, as follows: week.
Previously published tip sheets can be found on the Electronic Visit Verification Important Message located under the subheading ‘At Providers are encouraged to bill according to the Medicaid week because often Your Fingertips’. the frequency of a clients’ prior authorization (PA) indicates how many units can be used per week. If a claim for a service is submitted that exceeds the
frequency of the PA the claim will deny payment.
Example of Frequency:
The image above indicates a frequency of 252 units per calendar week for the service being performed.
When providing a PA the access agency will state how many units a week the agency receiving PA is to service the client, while the plan of care may indicate how those units are to be serviced each week. For example, an access agency Not sure who to contact has asked a provider to service a client 7 days per week for 9 hours per day. As when you have a the service has a per 15 minute unit increment, 36 units of service should be question or issue? provided per day. As the service is to be provided 7 days per week, the weekly units authorized are 252 units.
Contact DXC Technology via e- It is important to note that not every PA will begin on a Sunday. If services are mail to: [email protected] started in the middle of the week, the frequency is calculated from the start
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day of service to the next Saturday which is the end of the first calendar week. The frequency restarts on Sunday, which is the beginning of the next calendar week.
To demonstrate what a claim should look like, let’s first examine what the claim should NOT look like.
The provider is given a PA for 252 units per week, with care beginning on Thursday. The provider believes that because the PA’s start date Figure 1 is on a Thursday that the PA must be scheduled from Thursday to Thursday. As a result, the caregiver is scheduled as demonstrated in Figure 1. By scheduling in this manner, the provider has exceeded the PA in the first full calendar week of service, Sunday thru Saturday, by 26 units. With the current schedule, when the provider submits claims within the first full calendar week of service, the units of service will be cut back to only pay a total of 252 units for the week, as authorized by the Access Agency.
Figure 2 demonstrates the correct way to schedule and bill based on a frequency of 252 units per week, if services began on a Thursday. For example, in the first week the Figure 2 caregiver provides 36 units of service per day for a total of 108 units. In the next full week the caregiver is scheduled for and performs 36 units per day for a total of 252 units.
Paying attention to the Medicaid calendar week of Sunday through Saturday is an important and necessary step in correctly billing and properly understanding and calculating your frequency to avoid unnecessary denied claims.
Page | 2 of 2 Tip #34 - What is the Medicaid Week? Category: Claims