Home Health Billing in Virginia

Yes. Medicaid runs as Cardinal Care, delivered largely through commercial managed care plans. So most Virginia Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

CGS Administrators (J15 home health and hospice). Home health and hospice claims have their own Medicare contractors, separate from the Part A/B contractor for Virginia. It processes the claims, publishes the local coverage determinations that bind you, and hears the first level of appeal.

The specialty causes first: physician did not certify the plan of care inside the window; face-to-face encounter not documented; visit frequency exceeding the plan of care. On top of those, Virginia Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.

Virginia is a tort state for auto injuries, so standard coordination of benefits applies rather than an auto carrier taking first position. The injury still has to be identified at registration, because liability coverage may be primary for the related care.

Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our pricing in Virginia is set accordingly, and it is confirmed in writing before any work begins. That describes what we charge; your own position is a question for your counsel rather than for us.

Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. Episode-based billing where the physician must certify and re-certify the plan of care inside defined windows.