Kentucky Workflow

Overview 

(As always, private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid billing in the state of Kentucky.) 

In the state of Kentucky, there are some unique billing processes. Medicaid visits must be completed using electronic visit verification (EVV), and these verified visits are required to be sent to the state's default EVV provider as their statuses change. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver your visit data to Tellus on a near-real-time basis to ensure your state's requirements are met. This article will help guide you through this process.

This article covers:

Set-up

Testing

Pre-Billing

Billing Management for Medicaid non-EVV Visits

Billing Management for Medicaid EVV Visits

Remittance Advice Management (835s)

Corrected Claims

Further Details

Critical Pathway

For a simple overview of key admin system maintenance, see this overview with linked steps: Kentucky Critical Path PDF.pdf

Set-up

Ankota users in Kentucky must register for Tellus EVV. (Ankota will deliver visit data to Tellus.) This registration will ensure Tellus will accept their data and give providers access to the Tellus log-in. 

Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.

Testing

No state testing processes are required. Organizations may begin billing Tellus per the directions below once they have been configured to do so by their Ankota specialist. 

Pre-Billing

General Management

Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing. 

• Client Management
  • Setting Authorized Service for Clients (entering authorizations)
  • Schedule Visits - Calendar-Based Scheduling (or for those who prefer the classic approach, Creating Visits from Patterns)
• Visit Management
  • Caregivers complete visits or timesheets are entered manually through the office
  • Visits are approved automatically or visits are approved by office
    • More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
    • Note that Tellus visits require Reason Codes if they are missing critical EVV data such as a clock-in, clock-out, GPS data, or telephony data
    • Note that cost sharing / copay functions can be managed in Ankota if desired - request configuration if you do not have this feature
• Prevention of Errors/Unmatched/Rejected Claims
  • Watch your warnings on the Action Center (for missing auths, primary diagnosis codes, IDs, etc.) and address as needed
  • Watch your warnings on the Visit Approval Dashboard and address as needed
  • Ensure that name spellings, First Name/Last Name separation, Medicaid ID, and DOBs are entered correctly
  • (And if those preventative actions fail, watch for Rejection Response Files and address those issues as needed)

Cancellations

For visits sent to Tellus, cancelled visits must be assigned to a caregiver. (Visits without a caregiver name will be rejected.) Caregivers' names are collected by Tellus to provide transparency for all advance cancellations. In other words, this function makes a caregiver's reliability/attendance visible. However, this caregiver name can be a simple placeholder; for this reason, Caregiver Not Available is a defaulted "caregiver" in many systems. 

Best practice is as follows: 

• For companies where clients are routinely assigned different caregivers, assign a visit which is cancelled in advance to the caregiver Caregiver Not Available before cancelling. This will make it make it clear this is a scheduling issue and not a caregiver attendance issue.
• For companies where clients typically work with the same caregivers, leave the visit assigned to the defaulted caregiver before cancelling the visit. This will make it clear this is an availability issue with this specific caregiver. 
  • If a caregiver cannot cover a visit but you are given enough notice to find coverage with another caregiver, simply assign the visit to the alternate caregiver. There is no need to cancel the visit when the visit is successfully rescheduled.

If you would like to add a generic Caregiver Not Available (Caregiver first name, Not Available last name), you may do so at any time. Alternately, you may ask Ankota Support to add this caregiver.

Billing Management for Medicaid EVV Visits (TELLUS/Netsmart billing)

The following visits types must be delivered to Tellus: Kentucky EVV Services.pdf See here for further details. 

See here for a detailed overview of Tellus/Netsmart billing. (This overview includes a link to the critically important articles for reason codes and reading Tellus/Netsmart response files, as well as how to manage cancellations. Another helpful article is managing data exports, which clarifies single-export corrections.)

Note: Tellus should receive all authorizations directly from the state, so if you see a client is missing an authorization in Tellus, reach out to Tellus right away. 

Note: Once the visit has reached the status of completed, the visit will move to the Work List and will be available to release for billing. Once visits are in the Work List, Netsmart will no longer accept further updates from Ankota. You will need to fix any remaining issues in Tellus/Netsmart at that point.

Note: Tellus/Netsmart should receive all authorizations directly from the state, so if you see a client is missing an authorization in Netsmart, reach out to them right away.

Billing Management for Medicaid non-EVV Visits (KYMMIS billing)

Non-EVV visits should be billed via the state portal. 

• Schedule visits as usual; caregivers clock in and out as usual
• Manage visits as usual
• Calculate Billing
• Review the Billing Report (Client) and complete invoices
• Bill

Remittance Advice Management (835s)

Remittance advice files, or 835s, are provided in response to filing Medicaid claims. Think of these like state receipts of payments. These files can be uploaded to Ankota for an automatic application of payments in the A/R records. KYMMIS can make this available. 

• Process Remittance Advice(Upload 835 "receipts" received from KYMMIS into Ankota)
• Post Manual Payments
• Review Billing Reports
  • See also: Collections Report, Exceptions Report

Corrected Claims

Generally, claims corrections are handled one of two ways:

• Update the claims in Ankota and re-send
• Update the claims in the location where it was sent (such as Tellus/Netsmart or the state KYMMIS portal)

KYMMIS

For KYMMIS billing, you can correct the claims as needed by canceling the invoices and associated payrolls, correcting the data, and rebuilding the invoices as needed for upload. 

TELLUS/Netsmart

The key to understanding how data is managed between Ankota and Tellus is as follows:

• Any visits which receive acceptance response files from Tellus/Netsmart in Ankota successfully transferred a status update to Tellus/Netsmart. 
• Any visits which receive rejected response files from Tellus/Netsmart in Ankota did not successfully transfer a status update to Tellus/Netsmart
• Once a visit is completed (closed/invoiced) AND accepted, that visit is no longer editable in Ankota. Any further updates must be made in Tellus/Netsmart.

Rejected visits in Ankota must have data corrected in Ankota first, then the data must be re-sent to Tellus by moving the invoice from Draft to Complete. (For information on what data to correct, check the response file.) If you see a rejection response, this is a great opportunity to fix an issue and still be able to send out the data. 

Completed AND accepted visits will move to the Work List and will be available to release for billing in Tellus/Netsmart. At this point, any errors in Work List claims must be corrected in Tellus, and Tellus will no longer accept further updates from Ankota. 

We generally recommend you use the Approval Assistant to simplify your visit corrections process. Please note you should ONLY use the Duration adjustments section if there are known, strict limitations on the allowed work duration for the selected visit type.

For more information on Tellus/Netsmart training, go to Training Webinars - Mobilecaregiverplus.com

Further Details

For a more detailed walkthrough on the Tellus/Netsmart claims billing process, see the Tellus/Netsmart walkthrough.

For more information on rejection reasons, see Tellus/Netsmart Response Files.

For more information on reason codes, see Tellus/Netsmart Reason Codes.

Rebilling Claims that never were received by Payer, see Rebilling