The state of Missouri has changed regulations regarding unit rounding for home care agencies billing Medicaid. Agencies must now account for "accrued minutes" differently to comply with the new rules.

The state will now round down billable units for shifts. However, the minutes "lost" from rounding become "accrued minutes," so they do not have to actually be lost. We have developed a new process to ensure those minutes are properly counted for reimbursement.

To help you stay compliant, we have released a new billing workflow for Accrued Minutes Visits (AMV).

What is an AMV?

An Accrued Minutes Visit (AMV) is a specialized billing workflow designed to capture billable time that was not a full unit at the time of the original service.

The Challenge: Caregivers often work shifts that are rounded down to the nearest full unit when submitted, per new state guidelines.

The Solution: AMVs provide a way to bill for those accumulated minutes that were “lost” during the original visit.

Tracking Accrued Minutes?

Before creating an AMV, you must determine how many units you have available to bill.

Current Reporting: Sandata (EAS) released an AMV report that agencies can use to track AMVs.

Example Scenario: In the example below, the caregiver clocked in and out for his shifts, but 30 minutes of time (or two 15-minute units) were not billable because they did not fit into the rounded full units for those specific days.

• The caregiver clocked out late on the 24th and lost 5 minutes of accrued time to rounding.
• The caregiver clocked out late on the 26th and lost 9 minutes of accrued time to rounding.
• The caregiver clocked in early on the 27th and lost 6 minutes of accrued time to rounding.
• The caregiver clocked out late on the 28th and lost 10 minutes of accrued time to rounding.

How to Create an AMV

Availability: This feature is currently available for Medicaid service types and must be specifically enabled by Rosemark Support for your database. Once enabled, you’ll see a new option: Add Accrued Minutes Visit.

To schedule an AMV, follow these steps in the Planner:
1. Create Shift: Right-click on the top portion of the Client Planner, just as you would when adding a normal shift. A window will appear asking you to enter the start and end time for the AMV.
2. Selection Option: Choose the “Add Accrued Minutes Visit.”
3. Define Time: A window will appear requesting the start and end time. Enter the range for the AMV.

Note: Rosemark automatically assigns the “Accrued Minutes” caregiver to this shift. These visits differ from normal visits and have limited functionality to prevent errors.

AMV Criteria

AMVs function differently than standard visits to prevent errors. Please take note of these criteria:

• An AMV visit can only be Assigned, Verified Complete, or Office Canceled.
• An AMV can only have the “Accrued Minutes Caregiver.”
• An AMV must be submitted in complete units (usually a 15-minute unit).
• For a valid AMV, there must be at least one other shift scheduled prior to the date the AMV is scheduled.
• AMV must be submitted in the same month the units were accumulated (e.g., AMV for shifts that took place in November must be added to the client’s planner in November).

EVV Compliance and Syncing

Because AMVs are administrative, they require manual EVV entry to sync with state agencies.

Workflow:
1. Add Manual Events: You must add manual EVV for the missing clock-in and clock-out.
2. Select the Reason: AMV visits will only have one option when acknowledging the manual EVV event: Accrued Minutes Visit.

3. Completion: Once added, the shift status changes to Verified Complete and is ready for syncing. If at any point you need to change or cancel the shift at a later date, you can do so in line with the existing process for updating shift information.

Note: Manual EVV entries for AMVs are NOT counted against an agency's overall manual EVV percentage. The system has specific rules to ensure you are not punished for this workflow.

Best Practices for Using AMV

Frequency: While the state allows one AMV per client per day, most agencies do not submit them daily

Recommendation: Submit a single AMV per client near the end of the month, but avoid waiting until the very last day.

• Why? If an error occurs and the AMV must be canceled, the system will not allow you to create a replacement AMV on that same date. If this happens on the last day of the month, you will be unable to reschedule the visit within the required billing month.
• Best Practice: Schedule the AMV one to two days before the month ends to ensure you have a "safety buffer" to make corrections if necessary.