Maximizing Medicaid: Simplifying Home Care Success In Tennessee
As of July 1, 2024, Tennessee Medicaid has increased reimbursement rates for home care services, making the market a highly attractive opportunity for home care agencies. With high rate limits and promising market outlooks, Medicaid home care offers significant growth potential. However, providers may encounter challenges due to the complexities of navigating multiple systems, including intricate billing processes and Electronic Visit Verification (EVV) requirements. These administrative burdens can detract from their core mission of growth and success. Paradigm addresses these challenges by easing the administrative load. Our solutions automate billing, streamline EVV data, and more, allowing agencies to focus on maximizing their market potential and positively impacting the lives of their clients.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinTennessee.
Electronic Visit Verification
EVV (Electronic Visit Verification) is a technology used to verify that home or community-based service visits occur, ensuring that services are delivered to care recipients and that providers only bill for services rendered. Providers often find EVV to be a complex system to navigate so here we clarify a few key points for you:
EVV Requirements:
Tennessee has an unorthodox model in which MCOs choose their EVV vendor. Providers may alternatively use any approved EVV which integrates with the vendor chosen by the MCO/s they belong to.
EVV Aggregator:
The three MCO chosen aggregators are Sandata, CareBridge, and Therap. These aggregators handle the transmission of all EVV data to the payer. To ensure compliance and prevent payment and audit issues all claims must follow EVV guidelines.
Billing Process:
Providers submit claims through the state portal TennCare or through MCO approved portals/clearinghouses.
Rates
As of July 1st, 2024, Tennessee home care Medicaid reimbursement rates go up to $25.96 per hour. This recent rate increase combined with a high volume of authorized hours translates into wages beckoning with promise and potential.
However, it is important to note that reimbursement rates under MCOs may vary based on individually negotiated contracts. To secure the best possible rates, providers must carefully evaluate contracts, ensuring full understanding and compliance.
Payers
Tennessee’s Department of Disability and Aging (DDA) has a state program called TennCare which authorizes and disperses all Medicaid for the state.
There are 3 MCOs under TennCare: Wellpoint (formerly AmeriGroup), BlueCare and TennCare Select (under BlueCross BlueShield), and UnitedHealthcare.
Additionally, TennCare provides three Home and Community Based Service (HCBS) waiver programs which cover personal assistance services.
