5 Medicaid PCS Billing Mistakes That Will Trigger an Audit

Medicaid Personal Care Services (PCS) audits have become more aggressive nationwide. Here are five errors that almost guarantee a recoupment.

1. Billing without a current assessment If the assessment expired, every claim after that date is unsupported. Track expirations 30 days out.

2. EVV gaps and manual edits Excessive manual time entries are the single biggest audit trigger. Train staff to clock in and out from the home.

3. Care plan does not match tasks billed If the plan authorizes bathing and toileting but the visit note says "light housekeeping," the claim fails.

4. Supervisory visits missed Most states require an RN supervisory visit on a defined schedule. A missed visit invalidates billing during that period.

5. Caregiver credential lapses Expired TB, CPR, or background re-checks make every visit during the lapse non-billable.

A quarterly internal audit using these five categories will save tens of thousands of dollars in recoupments.