Medi-Cal EPSDT documentation vs State Controller demand

[CharlaRN]

I am an Independent Nurse Provider with Medi-Cal, In Home Operations, Home and Community-Based Services.

I care for a Medically Fragile child in my home, and bill Medi-Cal. It's been a win-win situation for 4 years. Medi-Cal approves of my home documentation, but, there are rumblings from the State Controller's office with the thought that the 12 hour shift documentations are "not enough" to warrant 12 hour billing - and the State of California may want to be reimbursed for what they (the State Controller office) is calling "not enough" documentation to support 12 hours of care in a home.

Please, anyone here who works as an Independent, or in Home Health, can you e-mail me a blank documentation form that you use? The idea that the State Controller's office can bypass Medi-Cal and go to individual nurses to demand money to be returned because they (the office ladies) don't feel there was "enough documentation" from the RN to warrent payment is a scary situation. We are Home Based, and DON'T document like the ICU. In fact, I was told, in a home visit by Medi-Cal EPSDT, that I was documenting too much and to document pertinent information, and use check marks. Again, Medi-Cal is happy with my documentation, Medi-Cal is who I bill - it's the State Controllers office who cuts the check and is looking for "fraud" in what they consider "not enough documentation to warrent paying a nurse 12 hours a shift".

My fax # is 1-314-689-8160