Resources

The Top Reasons Agencies Fail Medicaid Audits—And How to Avoid Them

Written by Cubhub | Apr 14, 2025 1:00:00 PM

Medicaid Home Care Agencies Are Facing a Compliance Crisis

Medicaid audits are on the rise—and even small errors can have big consequences. From incomplete EVV logs to unverified claims, many agencies are getting caught by preventable issues that lead to denials, penalties, or lost funding.

By understanding the common mistakes flagged in recent Medicaid audits, your agency can take proactive steps to avoid costly issues.

1. Incomplete or Inaccurate EVV Records

One of the top reasons Medicaid claims are denied is missing or incorrect Electronic Visit Verification (EVV) data. Common EVV issues include:

  • Visits not properly recorded or verified
  • Discrepancies between scheduled and actual visit times
  • Caregivers failing to check in or out correctly

Agencies that integrate EVV with their EMR system eliminate these risks by ensuring real-time tracking, automated visit verification, and accurate documentation.

2. Documentation Gaps That Lead to Claim Denials

Auditors frequently flag agencies for incomplete or inconsistent documentation. This includes:

  • Missing care notes or physician orders
  • Mismatched patient records across systems
  • Lack of proof that services were actually provided

A fully integrated EMR system helps ensure every patient record is accurate, complete, and audit-ready at all times.

3. Billing Errors That Trigger Scrutiny

Many agencies unknowingly make billing mistakes that lead to payment delays or denials, such as:

  • Overbilling or underbilling due to manual errors
  • Submitting claims with missing service details
  • Inconsistencies between EVV records and billed services

With an integrated billing system that syncs directly with EVV and EMR data, agencies can prevent claim errors before submission, reducing audit risks and speeding up payments.

4. Non-Compliant Scheduling Practices

Another audit red flag is caregivers providing services outside of approved hours or performing tasks they aren’t authorized for. Medicaid programs require:

  • Care plans to align with authorized service hours
  • Proper caregiver credentials for specific tasks
  • Strict adherence to visit schedules

A real-time scheduling system ensures visits stay within approved parameters, keeping agencies compliant.

How Cubhub Helps Agencies Stay Audit-Ready

Cubhub eliminates the risks of Medicaid audits by integrating EVV, EMR, and billing into one seamless system. With built-in compliance tracking, real-time documentation, and automated claim validation, agencies using Cubhub can:

  • Ensure every visit is verified and documented
  • Reduce billing errors and denials
  • Stay ahead of Medicaid rule changes

Don’t wait for an audit to expose weaknesses in your system. Schedule a demo today to see how Cubhub helps agencies stay compliant and financially secure.