What is the case manager's role in meeting the financial accountability assurance?
As a case manager, you are not directly involved in the bills submitted by direct care providers; however, you have a role in assuring and verifying that:
- A participant is enrolled on the HCBS waiver before services are ordered or provided.
- Services are authorized in the service plan.
- There is no duplication of services between Medicaid and other payors (such as Medicare).
- Services are provided in accordance with the service plan.
As a case management agency, your organization is also considered a provider. Therefore, your agency may be audited by the state to review the amounts billed for case management services. It is important that you document your contacts and visits with participants. In this way, your agency will be sure to be paid for the services you provide.
