As a reminder for Agency Providers delivering Homemaker/Personal Care to individuals that share services, in the same site, as a Daily Billing Unit (DBU), via DODD’s Medicaid Services System (MSS), please review the following:
After entering all actual staffing hours for the month, be sure to check the ‘Month Complete’ box in MSS. This is a crucial step that enables system validation and reconciliation of your data.
Once you mark the month complete, MSS will automatically notify you if your actual hours are above or below the 3% variance threshold in accordance with OAC 5123-9-31. A pop-up box will appear detailing the discrepancy.
If the actual hours are above the threshold: Review with the individual’s team. Was there a change in the plan? Were enough unscheduled hours included in the initial projection? Be aware that staffing above the projected hours means services delivered, but not reimbursed.
If the actual hours are below the threshold: Also, review with the individual’s team. Consider if you were short-staffed. Were services delivered as planned? Additionally, a recalculation of the previously billed claims for that month should be completed. Download the ‘MBS’ bill file from MSS to access the month-end DBUs. Compare to your previously submitted claims for that month. This represents overbilling. The claims shall be resubmitted for DODD to recoup overpayments.
For details, see Frequently Asked Questions, or reach out to us!
If you have questions, please Email Our Service Team.
