Home Health Care Agency Guide to Getting Paid During Appeals

Your Home Health Care Agency won’t stay in business if you can’t get paid!  DMA’s site has a new “how to get paid” guide, located at http://www.ncdhhs.gov/dma/provider/URVendorInstruct.pdf .  This guide makes a few points that are worth going over:

First, it is imperative to get your clients ready for letters from DMA or CCME which cut their hours.  They should know that they will have only ten days to get their appeal filed, and that your home health care agency will help them get this done pronto – no delay!  If the appeal isn’t filed in the ten day window, your clients’ right to keep their hours stops until the appeal is received.  This can cost you a lot!

Second, don’t let your client file their own appeal, especially without your home health care agency being named as representative!  Why so? Simple:  clients will be confused and intimidated and will not know what to say without you; CCME won’t give you key hearing dates, so your staff will not play a role; DMA will keep the result of the appeal a secret from you; and you will pay the aide but DMA won’t pay you.

Third, DMA has finally set some standards which CCME and other vendors will have to meet in handling appeal cases.  CCME must get the Maintenance of Service authorization completed within five business days from their receipt of the appeal.  So, keep your fax transmit report, to prove when the appeal was sent!

This posting adds to the advice in October 2010 Basic Medicaid Billing Guide, found on DMA’s site at:


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