Unlocking Growth: Simplifying Medicaid Management for Home Care Success
Georgia Medicaid, with its attractive reimbursement rates, offers a wealth of opportunities for home care agencies. However, the complexities of managing multiple systems, from intricate billing processes to Electronic Visit Verification (EVV) requirements, often pose significant challenges for providers. These administrative hurdles can divert attention from their primary goals of growth and delivering quality care. That's where Paradigm steps in. By taking over the burdensome back-office tasks—automating billing, streamlining EVV data, managing payment posting, and ensuring client eligibility—Paradigm allows agencies to focus on maximizing their potential and making a meaningful difference in their clients' lives.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinGeorgia.
Electronic Visit Verification
Navigating EVV and Medicaid billing in Georgia can be challenging. EVV is a system mandated by the federal government to confirm that home or community-based service visits take place as scheduled. Its primary goal is to ensure that members receive the services they need, while providers bill accurately for the services provided. Here is a simplified overview to help you understand:
EVV Requirements:
Georgia uses an open vendor model allowing providers have the flexibility to choose between using the state-sponsored EVV aggregator, Netsmart, or opting for an alternative EVV system that integrates seamlessly with it.
EVV Aggregator:
As the state aggregator, Netsmart is responsible for transmitting all EVV data to the payer. To maintain compliance and avoid payment or audit issues, it is vital that all claims adhere to EVV guidelines.
Billing Process:
Providers can submit claims directly through the state portal (GAMMIS) or by utilizing a third-party clearinghouse.
Rates
The current Medicaid reimbursement rates in Georgia average between $22.32 to $25.52 per hour, more than triple Georgia’s minimum wage. These rates are also set to be increased in the next few years, increasing the attractiveness of Medicaid reimbursement wages.
It is important to recognize that rates for Care Management Organizations (CMOs) can vary due to the individual negotiation of contracts with agencies. While the growth potential is significant, agencies must conduct detailed evaluations of CMO contracts to secure the most favorable rates. Thorough reviews are crucial to ensuring that agencies maximize their opportunities and achieve optimal financial outcomes.
Payers
Georgia’s Department of Community Health (DCH) authorizes and disperses all Medicaid for the state. There are 3 CMOs (Care Management Organizations) contracted under the state to provide coverage of personal care services to Medicaid beneficiaries. The 3 CMOs are as follows: Amerigroup, Peach State, and CareSource. The DCH also offers the Community Care Services Program (CCSP) under its Elderly & Disabled Waiver Program.
