{"product_id":"virginia-medicaid-bundle","title":"Virginia Medicaid Bundle","description":"\u003cp\u003e\u003cspan\u003eVIRGINIA MEDICAID HOME CARE APPLICATION, POLICIES \u0026amp; MCO CONTRACTING ACCELERATOR\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eEight-Week Coaching and Mentorship Program\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eBuild a compliant Virginia home care agency, prepare your Medicaid provider enrollment application and pursue contracts with Virginia’s Cardinal Care managed-care organizations.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eThis eight-week coaching program gives Virginia home care agency owners step-by-step guidance through:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Virginia Department of Health home care licensure compliance\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia Medicaid provider enrollment\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• PRSS and MES portal navigation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• CCC Plus Waiver provider requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency-directed personal care and respite services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Policies and procedures\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Cardinal Care MCO credentialing and contracting\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Electronic Visit Verification\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service authorization and billing readiness\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Referral development and client acquisition\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003ePROGRAM TUITION\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eStandard Coaching Program: $3,500\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003ePayment Plan:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Four payments of $950\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Total payment-plan price: $3,800\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eVIP Done-With-You Program: $5,500\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eThe VIP program includes individual application-document reviews, policy customization support, two private strategy sessions and review of up to five MCO contracting packets.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eVIRGINIA PROGRAMS COVERED\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eThis course focuses primarily on:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Agency-directed personal care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency-directed respite care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• CCC Plus Waiver services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia Cardinal Care managed care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Medicaid home and community-based services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Skilled home health or private-duty nursing readiness, when applicable\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eConsumer-directed services facilitation, DD Waiver services, Medicare certification and private-duty nursing have different participation requirements. These subjects may require separate provider enrollments or specialized training.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 1 — VIRGINIA HOME CARE AND MEDICAID READINESS\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Virginia Home Care Organization classifications\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Home health services versus personal care services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Skilled versus non-skilled home care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency-directed versus consumer-directed services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia Department of Health’s role\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• DMAS and Virginia Medicaid’s role\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• CCC Plus Waiver overview\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Cardinal Care managed care overview\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Medicaid enrollment versus MCO contracting\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Determining which services your agency qualifies to provide\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Completing an agency readiness and gap assessment\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Complete the Virginia Medicaid Readiness Assessment.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 2 — VIRGINIA LICENSING AND ORGANIZATIONAL COMPLIANCE\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Virginia Home Care Organization license review\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia Code §32.1-162.7 and related home care laws\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• 12VAC5-381 Home Care Organization regulations\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Governing-body responsibilities\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Administrator and nursing-supervisor requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Liability insurance and fidelity-bond requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Business-name, EIN and ownership consistency\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Organizational Type 2 NPI\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Taxonomy selection\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service location and office readiness\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Criminal-background and barrier-crime requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Employee and contractor qualification standards\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Drug-free workplace policies\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Preparing for VDH inspections and home visits\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Assemble the agency’s licensing and organizational compliance folder.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 3 — VIRGINIA MEDICAID PRSS\/MES ENROLLMENT\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Creating access to the Medicaid Enterprise System\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Navigating the PRSS Provider Portal\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Selecting the appropriate provider type and specialty\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• New enrollment, revalidation and maintenance requests\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Legal name, ownership and controlling-interest disclosures\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service location and pay-to information\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• License, insurance and accreditation documentation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Managing-employee disclosures\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Federal and state exclusion screening\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Electronic funds transfer documentation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Provider participation agreements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Tracking an application\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Responding to deficiencies\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Adding specialties after enrollment\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Updating licenses and demographic information\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Avoiding application inconsistencies\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Complete the Virginia Medicaid Application Preparation Checklist.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 4 — CCC PLUS WAIVER PROVIDER REQUIREMENTS\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• CCC Plus Waiver eligibility and LTSS screening\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency-directed personal care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency-directed respite care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Separate provider agreements and provider IDs\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Registered nurse qualifications\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personal care aide qualifications\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Employee orientation and annual training\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• RN supervision requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Initial assessments and plans of care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• DMAS-required forms\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Scheduled services not provided\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Changes in condition\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service limitations and authorization requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Legally responsible individuals\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Nurse-delegated tasks\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personal care versus skilled services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Member freedom of choice\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Preventing institutional placement through home-based services\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Complete the CCC Plus Provider Participation Audit.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 5 — VIRGINIA POLICIES AND PROCEDURES\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eParticipants receive an editable Virginia-focused policy-and-procedure framework addressing:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Governing-body responsibilities\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Management and administration\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Admission and eligibility\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Informed-consent agreements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Client rights and responsibilities\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Nondiscrimination and accessibility\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Complaints and grievances\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Abuse, neglect and exploitation reporting\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Patient assessment and reassessment\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Plans of care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personal care services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Respite services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Skilled services, when applicable\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Medication assistance\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Nurse delegation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• RN supervision\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Employee qualifications\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Background checks and barrier crimes\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personnel records\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Orientation and annual training\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Competency evaluations\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Employee and contractor supervision\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Infection prevention and control\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Emergency preparedness\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Continuity of operations\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Incident reporting\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Clinical and service records\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Record retention and confidentiality\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• HIPAA privacy and security\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Quality improvement\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Utilization review\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Medicaid eligibility verification\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service authorization\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Electronic Visit Verification\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Billing and claims integrity\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Overpayments and refunds\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Fraud, waste and abuse\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Federal and state exclusion screening\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Marketing and prohibited inducements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Discharge and transfer\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Business closure and client transition\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Customize the required policies for the agency’s approved services and staffing structure.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 6 — DOCUMENTATION, EVV AND BILLING READINESS\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Verifying Medicaid and MCO eligibility\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Confirming authorization before starting care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Understanding authorized hours and service dates\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Electronic Visit Verification requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Correcting EVV exceptions\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personal care aide records\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• RN supervisory notes\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• DMAS-99 and related service documentation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Plan-of-care updates\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Missed and refused visits\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Changes in member condition\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Incident documentation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Service notes and time records\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Avoiding overlapping and duplicate services\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Procedure codes, units and modifiers\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Clean-claim preparation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Timely filing\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Claims reconsiderations and appeals\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Overpayments and recoupments\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Preparing for DMAS and MCO quality-management reviews\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Complete a mock member-record and claims audit.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 7 — CARDINAL CARE MCO CONTRACTING\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eParticipants will learn how to pursue contracts with:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Aetna Better Health of Virginia\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Anthem HealthKeepers Plus\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Humana Healthy Horizons of Virginia\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Sentara Health Plans\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• UnitedHealthcare Community Plan\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eTraining includes:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• State enrollment before MCO participation\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Provider-interest and network-participation forms\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Credentialing versus contracting\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Preparing the MCO contracting packet\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agency roster and service-location records\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Ownership and credentialing disclosures\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Building a home care capability statement\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Writing a network-participation request\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Presenting service capacity and geographic coverage\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Responding to a closed network\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Credentialing follow-up schedules\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Tracking submissions and outstanding documents\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Verifying participating-provider status in PRSS\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Reviewing fee schedules and reimbursement terms\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Authorization and notification requirements\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Provider-directory verification\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Contract implementation after approval\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Prepare contracting packets for all five Cardinal Care plans.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWEEK 8 — REFERRALS, CENSUS DEVELOPMENT AND 90-DAY PLAN\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Introducing the agency to MCO care coordinators\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Building relationships with hospitals and rehabilitation centers\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Working with LTSS screening teams\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Connecting with Area Agencies on Aging\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Discharge planner and social worker outreach\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Nursing facility transition opportunities\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Physician and healthcare-provider relationships\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Veteran and disability referral partners\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Community outreach compliance\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Preparing a referral packet\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Responding to referrals professionally\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Tracking inquiries, authorizations, admissions and starts of care\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Developing a staffing pipeline before accepting cases\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Creating a 30-, 60- and 90-day contracting and census plan\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eHomework: Complete the Virginia 90-Day Medicaid Contracting and Referral Plan.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWHAT IS INCLUDED\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Eight weekly live coaching sessions\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• One private strategy session\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Session recordings\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia Medicaid readiness assessment\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• PRSS\/MES application checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• CCC Plus provider participation checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Virginia policy-and-procedure framework\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Policy customization guide\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personnel-file checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Member-record checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• RN supervision checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• EVV compliance checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Quality-management review tool\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• MCO contracting tracker\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Five-plan credentialing checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Contracting emails and follow-up scripts\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Closed-network reconsideration template\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Capability-statement template\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Referral packet outline\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• 90-day implementation plan\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Mentorship and accountability during the program\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eVIP DONE-WITH-YOU PACKAGE\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eThe $5,500 VIP package includes:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Everything in the standard program\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Two additional private coaching sessions\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Individual PRSS application document review\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Review of the agency’s customized policies\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Review of up to five MCO contracting packets\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Personalized deficiency and corrective-action checklist\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Customized capability statement\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Customized 90-day contracting and referral plan\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eWHO SHOULD ENROLL\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003e• Virginia home care agency owners\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• VDH-licensed Home Care Organizations\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• License-pending agencies preparing for Medicaid\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Private-pay agencies adding Medicaid\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agencies pursuing CCC Plus personal care cases\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Providers struggling with PRSS enrollment\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Enrolled providers that have not secured MCO contracts\u003c\/span\u003e\u003cspan\u003e\u003cbr\u003e \u003c\/span\u003e\u003cspan\u003e• Agencies preparing for an MCO quality-management review\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eIMPORTANT DISCLAIMER\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eThis course provides education, coaching, templates and organizational support. It does not provide legal advice, guarantee compliance or represent participants before VDH, DMAS, Medicare or any managed-care organization.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eCompleting this program does not guarantee Home Care Organization licensure, Virginia Medicaid enrollment, MCO credentialing, network participation, reimbursement rates, referrals or clients.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eParticipants must maintain an appropriate Virginia license or recognized accreditation for the services they intend to provide. Each MCO makes its own contracting and network-participation decisions.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eAll templates must be customized to the agency’s services, license, staffing structure and payer contracts. Participants should obtain review from a qualified Virginia healthcare attorney or compliance professional when necessary.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eENROLL TODAY\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eStop allowing confusing Medicaid requirements, incomplete documentation and unanswered contracting requests to delay your agency.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eJoin Coach Brown for eight weeks of coaching, accountability and step-by-step guidance. Build your compliance foundation, prepare your Virginia Medicaid enrollment and pursue contracts with all five Cardinal Care health plans.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cspan\u003eClick “Enroll Now” to begin.\u003c\/span\u003e\u003c\/p\u003e","brand":"Abundant Living Home Care \u0026 Consultants ","offers":[{"title":"Default Title","offer_id":54051779543358,"sku":null,"price":3500.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/th3healthcarefairy.myshopify.com\/products\/virginia-medicaid-bundle","provider":"Abundant Living Home Care \u0026 Consultants ","version":"1.0","type":"link"}