Expert Billing & More, Inc.

National Provider Identifer (npi)

Providers of the Home and Community Based Waiver programs are EXEMPT from the NPI requirement.  There is information about it on the APD website.  Remember that the Medicaid bulletins you are receiving are for ALL Medicaid providers.

Some HCBS providers have chosen to obtain an NPI#. Even if you don’t need one, and choose to request one, that is fine.  Just let us know and we will log it in our system.  CLAIMS WILL NOT DENY W/O ONE.

State Plan PCA providers are NOT exempt and will need to obtain an NPI number.

THERE IS A NEW HANDBOOK FOR THE MEDWAIVER PROGRAM

Most of you probably are already aware that there is a new Handbook available for the Medwaiver program.  Providers can obtain a copy online at mymedicaid-florida.com.

If you haven’t already reviewed it, we strongly encourage providers to do so.  There are a lot of paperwork reduction issues incorporated into this version which could make your life easier. 

PCA for clients 21 and under

We’ve begun billing for some providers that already have their KePro approval.  If you plan to bill for State Plan PCA, please contact us as we have developed a different invoice format that contains all the required information needed to process claims.

Is Riverside National your bank?

As I am sure you are aware by now, TD Bank has taken over Riverside National Bank.  This change was effective 9/24/10.  Although Riverside/TD has assured its customers that this will be a smooth transition and that they don’t need to make any changes to their existing direct deposit accounts, WE STRONGLY encourage providers to verify that their direct deposit information is correct.  Providers may even want to complete a new change in banking form to be on the safe side.  However, keep in mind if that is done, there will be paper checks issued once the change is processed while the account information is being verified.

If you have not received your deposit as expected and were a Riverside National customer, the change could be the problem.  Contact Provider Enrollment at 800 289 7799 to inquire about the banking information on file.

PLEASE REMEMBER providers should be reviewing the remittance voucher to ensure that the claims were processed correctly and paid in full.  If there are any discrepancies, contact us immediately rather than waiting for the error to be discovered in an audit.

If you are unsure how to pull your voucher and think your payment was not accurate, just give us a call.  We can pull your voucher and research the issue.

Regular Office Hours
Monday-Thursday 8:30-4:30 pm / Friday 8:30-11:00 am

Holiday Hours

Thanksgiving Holiday:

     Wednesday, November 24: Close at Noon

     Thursday, November 25 & Friday, November 26: Closed all day

Christmas Holiday:

    Friday, December 24: Close at Noon

    Monday, December 27: Closed all day

    (providers should ensure that invoices are received 10 am on days we are closing at Noonso we have enough time to process them)

Duplicate Claim payments

Many of you may remember over the past year or so with the transition to the new fiscal agent, some claims were in fact paid twice.  As there was no clear direction given at the time, we did not do anything with the duplicate claims at the time. 

Unfortunately now we are hearing from a few providers that they are receiving letters from AHCA regarding duplicate paid claims.  The letter is rather harsh stating that if providers don’t resolve the duplicate payments (meaning pay the money back) on their own, the monies will automatically be deducted from future payments. 

BEFORE taking any action on this, please fax us the letter so that we can research it.  We have found in some instances, that the information contained in the letters was not accurate.  Hopefully this isn’t an issue for very many providers.

tier changes causing problems with authorizations

Almost everyone has been affected by recent tier changes causing problems with authorizations.  This has been a nightmare for everyone involved! 

Because of so many problems and rumors about not “backdating” authorizations, etc., we want to remind providers that it is imperative to keep ALL copies of authorizations received, even if they have changed.  In some cases, the original authorization is the only thing showing approval was given.  When trying to resolve an issue with a problem authorization, it is a good idea to keep records of all communication pertaining to the problem.  Try to communicate in writing whenever possible so that you can copy APD.

Hopefully APD/APS/EDS will figure out a way to fix all the glitches in the systems that are causing all these problems.

NEW INVOICE REQUIREMENTS – WE NEED ACTUAL ATTENDANCE DAYS

As you all know, we try to keep up with the changing requirements, which I’m sure you all know is not an easy task.

One of the major issues that have come out of recent Medicaid Program Integrity audits is billing.  These issues are very frustrating to us because we have been billing Waiver claims for over 10 years and are perplexed at how out of the blue, MPI/APD, etc. and just start saying “you can’t bill like that” and actually cite providers for billing in the manner we’ve been trained.  One of the problems is that there are conflicts between the Waiver Handbook and the Medicaid General Handbook.  APD has always done things their own way with regard to billing and it’s always been understood by Medicaid that APD providers do not always follow the same guidelines in the Medicaid General Handbook.

For whatever reason, this is all changing.  The “standard” billing practices that have been used by Waiver providers for years are now no longer acceptable according to Medicaid Program Integrity.  Apparently, there is a push to update both Handbooks to outline what is considered “standard” today.

The biggest issue on the table is the rolling up or lumping of claims.  In the past, according to “standard billing practices” we would roll up claims for certain services for the week or month.  Now they want us to only roll up consecutive dates of service. 

In order for us to comply with this new billing requirement, it is imperative that providers submit invoices that include actual dates of service.   If you have been simply submitting a “total’ for the week or month, you now must include all the actual dates of service.   We need to be sure that we are billing on an actual date of service.

And of course you are all aware that your service logs must match your billing invoice.

PLEASE REMEMBER providers should be reviewing the remittance voucher to ensure that the claims were processed correctly and paid in full.  If there are any discrepancies, contact us immediately rather than waiting for the error to be discovered in an audit.

If you are unsure how to pull your voucher and think your payment was not accurate, just give us a call.  We can pull your voucher and research the issue.

Regular Office Hours

Monday-Thursday 8:30-4:30 pm / Friday 8:30-11:00 am

Holiday Hours

Christmas Holiday:

Friday, December 24: Close at Noon***

Monday, December 27: Closed all day

New Year’s

Friday, December 31: Close at Noon***

Monday, January 3: Closed all day

(providers should ensure that invoices are received by 10 am on days we are closing at Noon

so we have enough time to process them)

***Please remember this is a FRIDAY so it is not guaranteed that claims submitted on this day will pay***

***It is best to submit your claims early in the week***