APA specializes in all aspects of waiver billing (including county and MSHO programs). Medicaid Waiver programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. Prior to 1991, the Federal Medicaid Waiver program paid for services only if a person lived in an institution. The approval of Federal Medicaid Waiver programs allowed states to provide services to consumers in their homes and in their communities. The Waiver program is all about client outcomes. That’s why we work with you, the case manager, the physician, the insurance carriers and, of course, your clients to ensure that those outcomes are met while navigating the maze of regulations we are all accountable to. With your help, APA works hard to balance the needs of your clients while maintaining fiscal responsibility to the taxpayers who fund these programs.
APA Medical is a Resource for Waiver Billing Questions
At APA Medical, we know how important understanding Waiver/MSHO programs can be to get products and services to those who need them. For that reason, we provide in-services for case management groups and individuals, either in-house or at their location. We also provide paper catalogs for quick and easy product lookup and a website (www.apamedical.com) that showcases our products and services, as well as many more resources.
APA Medical can process billing for most insurance: MA (medical assistance), Medicare, Ucare, Medica, HealthPartners, Blue Cross, and many others. We also work with the following waivers: EW (elderly waiver), CADI (Community Access for Disability Inclusion), DD (Developmental Disabilities), BI (Brain Injury), CAC (Community Alternative Care), CDCS (Consumer Directed Community Supports), and AC Grant (Alternative Care).
Two Decades of Experience in Waiver Programs
We have over 20 years of working with Waiver/MSHO programs and the ability to facilitate transactions with other suppliers of services that can’t bill waiver themselves. If you are able to utilize waiver billing, APA Medical can get you almost any product or service you require. We are constantly working with Case Managers to quickly get them the products and services they need for their customers.
Common and not so common instances in which APA can help:
Upgrades
Client or caregiver request an item no one will provide through insurance benefits because of cost. (Examples would be power patient lifters). APA will help you determine if the client really needs the upgrade and work on various ways we could provide.
Overages
Client needs more incontinence supplies than what DHS allows. APA will help you determine if client needs a different product to meet their needs or how we can cover the additional quantities required.
Professional Services Where the Provider Can’t Bill Waiver
APA can be the intermediary between the provider of a service and the billing to the waiver program.
Strange Requests for Equipment or Services
APA gets these requests all the time. Again, we will work with you to evaluate the appropriate nature and get you a quote.
In general, if there is any question you may have regarding either insurance or waiver billing, please feel free to contact us. If you are unsure of what another provider is telling you, even in that situation we are happy to confirm that what they are telling you is correct or, if we disagree, why.
Once again, providing assistance to you, the health care professional, is one of the things we are most proud of here at APA Medical. We hope that you never hesitate to reach out to us to see if we can assist you with any waiver billing transactions or questions.
