Some MO HealthNet-enrolled Private Duty Nursing (PDN) agencies are also enrolled to provide other types of services. For instance, a PDN agency may also be a provider of in-home services. Different program rules apply to PDN than to other programs.
In July, 2015, in-home services and consumer-directed services providers became required to use “telephony” to track the in and out times of services provided. This rule does not apply to PDN. However, some providers may choose to use their telephony systems for their PDN services as well. This may cause improper billing if the systems accrue units of service for PDN.
While the in-home and consumer-directed programs allow for accrual of units, the PDN program does not. Click here to read the PDN regulation (13 CSR 70-95). Click here to read the rules regarding accruing units in in-home or consumer-directed programs (13 CSR 70-91).
As well, the PDN program does not allow for rounding of units. Neither do the other programs. The PDN regulation states, “A unit of service is fifteen (15) minutes.” Rounding up is not allowed, as this can cause over-billing. The Missouri Medicaid Audit and Compliance Unit (MMAC) encourages all providers who use telephony systems to review their systems for compliance across their programs. The MMAC website has a link to a list of “Questions to Ask Potential Telephony (EVV) Vendors” that offers helpful guidance. This tool was prepared by members of the MO Alliance for Home Care’s CDS and State Programs Task Force.
If you have any questions, please contact MMAC at mmac.providerreview@dss.mo.gov