Matthew Rose, Regional Vice President of Sales:516-484-4400, ext. 4191 or firstname.lastname@example.org
"Verification organization" means an entity which uses electronic means including but not limited to contemporaneous telephone verification or contemporaneous verified electronic data to verify whether a service or item was provided to an eligible Medicaid recipient.
The legislation states that a participating provider “means a
a. certified home health agency
b. long term home health agency
c. personal care provider
with total Medicaid reimbursements exceeding fifteen million dollars per calendar year.”
This requirement will apply to Federal Employers (as defined by FEIN) with Provider ID’s which, in aggregate, directly submit Fee for Service claims as Certified Home Health Agencies, Long Term Home Health Agencies and/or Personal Care Agencies (excluding Consumer Directed).
No, however it is the VOs responsibility to ensure that all of the functions exist, and meet all of the requirements described herein. For each provider that employs the services of the VO, the VO must review and attest to the requirements being met in that particular implementation.
No, part of the role of a VO is to be third party control organization.
Yes. EVV must be employed and all resulting data must be collected and stored in a provider neutral repository which can be accessed by the DOH and the OMIG and their respective representatives.
At this time it is believed that skilled workers will be exempt from EVV during the initial implementation period.
Yes providers must ensure that all their employees are in compliance with regulations. The VO must verify that the providers systems have the appropriate checks and balances in place and checks against exceptions and sanction databases.
Yes. The VO must verify that the providers’ systems prevents claims from being submitted with exceptions or that all exceptions have been properly resolved.
Yes. Any instance of caregiver location conflict (caregiver is at two locations at the same time) must be identified and reported.
No, providers are never the VO. Each covered provider must engage the services of a VO.
The VO is required to review the interrelationships from the different systems and attest to the presence of the required checks and that there is no way for the provider to circumvent the controls.
There are no specific requirements related to authorizations. However, there must be reasonable checks to ensure the continuum from authorization to plan of care to scheduling to the actual and provision of related services.
They would be considered a weak link in the verification process, but the state has not ruled their use out at this point. The VO will need to be familiar with the system and will need to focus on and speak to the controls in place to give reasonable assurance that requirements can’t be bypassed.
At the present time Consumer Directed Personal Care is being exempted from the calculation for covered providers. Professional services staff are not subject to the requirements at this time.
Managed Long Term Care is not included, however fee for service managed care is included. With the exception of Consumer Directed, if fee for service claims are submitted for Home Health (COS 0260), Persona Care (COS 0264) or Long Term Home Health (COS 0388), they are used to determine covered providers. All of those services, with the exception of the professional component are subject to the EVV and cross edits.
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