Service Authorization, Units of Service, and Billing
The Agency bills only what DSDS authorized and its workers actually delivered: 15-minute units including EVV entry time but not travel or breaks, partial units only within the month, MO HealthNet eligibility checked for the day of service, claims based on EVV-verified delivery and never on the authorization, a monthly reconciliation before billing, no charge to MO HealthNet participants for covered services, and prompt repayment of overpayments.
About this policy
- Policy number
- MO-HC-BUS-01
- Version
- 1.0
- Main rule
- 19 CSR 15-7.021(17)
- Library
- Missouri home care · 50 policies
- Category
- Business
- Sections
- 17
In short
- The Agency bills only the time you actually spend giving authorized care in the participant's home.
- One unit is 15 minutes. Time for your EVV entry counts. Travel, lunch and breaks do not.
- Never record time you did not work or tasks you did not do.
- MO HealthNet participants are never asked to pay for covered services.
- If you think a visit was recorded wrongly, tell your supervisor the same day.
What's inside
17 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (19 CSR 15-7.021(17))
- 5. What May Be Billed
- 6. Documentation Supporting Each Claim
- 7. Monthly Billing Procedure
- 8. Billing Practices That Are Never Allowed
- 9. Errors, Overpayments and Repayment
- 10. Responsibilities
- 11. Records and Compliance Monitoring
- 12. Staff Training
- 13. References
- 14. Related Policies and Forms
- 15. Approval
- 16. Revision History
An inspector may ask
- Show me how you reconcile delivered units with the authorization before you bill.
- How do you verify MO HealthNet eligibility for the day the service was delivered?
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