How to Maximize Medicaid Reimbursements Without Risking Audit Violations

Smart Billing Strategies for AFC, HFA, and MI Choice Waiver Providers in Michigan

Medicaid reimbursements are the financial backbone for many Adult Foster Care (AFC) homes, Homes for the Aged (HFA), and MI Choice Waiver providers across Michigan. But as reimbursement opportunities grow, so do audit risks.

Trying to increase revenue without understanding Medicaid billing rules can quickly lead to denied claims, repayment demands, or even program termination. The good news? You can optimize your reimbursements legally and confidently — if you build the right systems.

In this post, you’ll learn how to strengthen your Medicaid billing process, avoid audit red flags, and make sure you're being paid for every eligible service you provide.

✅ Step 1: Know What You Can Bill For

Each Medicaid waiver agency (such as Region VII AAA or A&D Home Health Care) authorizes specific services for each client.

You may be able to bill for:

• Community Living Supports (CLS)

• Personal care or supervision

• Homemaking, meal prep, or light cleaning

• Respite care

• Medication reminders (not administration unless licensed)

• Transportation (in some cases)

Always check the current person-centered plan to verify approved services and units.

🧾 Step 2: Link Services to Documentation

Every billed service must be backed by:

• Progress notes that reflect what was done

• Time logs that match the units billed

• Staff names and roles

• Dates, times, and specifics of care

If you’re audited and the documentation doesn’t support the claim — you’ll likely have to pay it back.

🕒 Step 3: Track EVV and Waiver Billing Rules

As of 2024, Michigan requires Electronic Visit Verification (EVV) for most personal care services under the MI Choice Waiver.

To stay compliant:

• Use your agency’s approved EVV system

• Train staff on how to log services properly

• Make sure EVV logs match your billing and progress notes

Pro Tip: Review the Medicaid Provider Manual regularly for updates to billing codes, service definitions, and required documentation.

🧠 Step 4: Eliminate Billing Gaps & Missed Revenue

Many facilities under-bill or delay billing because:

• Staff forget to log services

• Admins aren’t trained on what’s reimbursable

• There's no system for reviewing claims before submission

To fix this:

• Create a monthly billing checklist

• Assign a billing lead or outsource it to a trained team

• Audit claims before submission for accuracy

📉 Step 5: Avoid These Common Medicaid Audit Triggers

• Billing for services not in the care plan

• Missing or vague progress notes (“assisted with ADLs”)

• Duplicate claims (two staff billing for the same time)

• No documentation for missed visits

• Improper premium pay tracking on payroll records

🛠️ Step 6: Build a Billing & Compliance System

To protect your facility and maximize Medicaid income:

• Store all billing-related documentation in one place

• Cross-check every claim with supporting notes and time logs

• Keep records for at least 10 years

• Train all staff on how their documentation affects Medicaid claims

🤝 Roseberri Can Help You Bill Confidently

At Roseberri, LLC, we help Michigan-based providers:

• Set up and manage Medicaid waiver billing

• Audit your existing claims and files

• Train your staff on EVV, documentation, and billing best practices

• Align your payroll with Medicaid wage tracking (e.g. Premium Pay)

📧 roseberrimanagement@gmail.com🌐 www.roseberri.com 📍 Serving all of Michigan remotely or in person

Final Thought: Bill Smarter, Not Riskier

You don’t need to fear audits — but you do need to prepare for them. When your documentation is tight and your billing process is clear, Medicaid reimbursements become sustainable income, not a source of stress.

Don’t leave money on the table — and don’t take shortcuts that could cost you later.