Unanswered PDGM and Medicaid

[MaggieW_45456]

I am with a company that is in the beginning phases of starting Home Health for their current individuals on Medicaid WAIVER services. So, most of our "patients" coming to Home Health have Medicaid and not Medicare.

My question is, I only know Home Health to bill under the PDGM. Does Medicaid also follow the PDGM or is it a different process for submitting home health claims?

If it is state specific, the state in question would be Indiana.

I feel overwhelmed!

 

[NadineE_92105]

It's completely understandable to feel overwhelmed. Transitioning to home health billing, especially with a new payer like Medicaid and a different reimbursement model, can be a significant learning curve. From my understanding Indiana Medicaid does NOT use PDGM for home health billing. PDGM is for Medicare. Indiana Medicaid has its own rules. You'll likely bill per visit using a UB-04 form with specific codes and require prior authorization for all claims.

I would suggest checking out the main Indiana Medicaid Provider website for any questions you might have. Here is the link:
https://www.in.gov/medicaid/providers/

Hope this helps.