Presentation on theme: "LTC POLICY AND PROCEDURE REVIEW"— Presentation transcript:
1LTC POLICY AND PROCEDURE REVIEW Greg LeahyProgram AdministratorNursing Facility Rates & PolicyMinnesota Department of Human Services(651)Robert Rodè, Esq.Voigt, Klegon & Rodè, LLC(651)
2Agenda Admissions Pre-admission screening Payment Responsibility Bed hold agreementBedholds/Leave day billingProactive billingLTC EligibilityLTC InsuranceOther payment issuesQuestions/discussion?
3ADMISSION AGREEMENT FORMS, POLICIES AND PROCEDURES Financial Information – You can ask for itRepresentative Payee StatusAuthorization for Release of Information for MAAssignment of Insurance BenefitsBed-hold Agreement - it’s a must have!
4PREADMISSION SCREENING – WHY? Who Cares?You do!Medical assistance denial of paymentFor a Medical Assistance recipient who has not had a pre-admission screening OR for services rendered prior to appropriate pre-admission screeningFor a Medical Assistance recipient who does not require nursing facility servicesMay not be able to bill private pay clients
5PRE ADMISSION SCREENING – WHEN? PRIOR to or ON day of admissionFirst working day after an emergency admissionWithin 40 days of admission if individual was admitted under a short-term exemptionALL residentsRegardless of:Current living situation (i.e. hospital, community, etc.)Income, assets, and payor sources
6PRE ADMISSION SCREENING – WHEN? Exception – Inter-facility transfersIndividual having entered into an acute care facility from a certified MN nursing facility is returning to the certified MN nursing facilityIndividual is transferring from one a certified MN facility to another certified MN facilityThese transfers are exempt because it is assumed the appropriate PAS occurred at the first facility admission
7PRE ADMISSION SCREENING – WHO? Who is Responsible?Pre-admission screening – LTCCCounty social worker and/or public health nurse EXCEPT those enrolled in the following pre-paid Medical Assistance programs:Minnesota Senior Health OptionsMinnesota Senior Care PlusMinnesota Disability Health OptionsLevel ILTCC intake team, county worker or public health nurseLevel IILocal mental health authority in the county where the person is seeking admissionThe professional seeking admission is responsible for ensuring the pre-admission screening is completed
8PRE ADMISSION SCREENING – HOW? TelephoneA telephone screening is only allowed between two (2) health care professionalsMost typically used when a resident is seeking discharge from a hospital to a nursing facilityFace-to-FaceAll other screenings are to be done with a face-to-face meetingWatch for Under 65 and Under 21 Requirements
9PAYMENT RESPONSIBILITY Check MNITS EligibilityRep Payee Status—who is it?Authorization for release of information—get one signed!!Counties may request this to give MA application updates
10PAYMENT RESPONSIBILITY, CONT’D… Will resident qualify for MA?Direct family/resident to county financial workerBriefly explain how MA works including spenddownChoose your words carefully---MA elig is determined by the countyExplain that Medicare may pay up to 100 days—not all at 100%
11A FEW THOUGHTS ABOUT BED HOLDS…WE’D NEED ANOTHER SESSION TO COVER EVERYTHING Federal and State Law Distinguish permitted post-admission Bed Hold from prohibited “pre-admission” bed hold payments.Notice Before Transfer AND at Time of Transfer.Language is important – choose your words carefully.Resident has choice:Continue to pay and ensure access to specific bed; orNot pay and rely on readmission.They are required – plus they can result in $Private pay vs. Medicare/Medicaid.Bill equally.Manage your/your facility’s expectations.
12LEAVE DAY BILLING NF Eligibility Allowable Days per Resident Facility must be above 93% occupancyRate reported with 24 value code and .93Allowable Days per Resident18 consecutive hospital leave daysPer each separate and distinct episode36 therapeutic days per calendar yearBed Hold Agreements
13LEAVE DAYS CONT’D Allowable Payments If NF at eligible occupancy level, provider paid 60% of RUG ratePrivate pay is charged 60% as wellIf NF below 93%, private pay can be charged up to 100% of RUG rateMA recipients must be charged the same if they wish to hold the bed
14PROACTIVE BILLING MNITS Eligibility MSHO/PMAP? NF liability days available?Hospice?Ineligible for LTC services?**(Form 3543)Spenddown?Preadmission ScreeningKnowing where recipient admitted fromWho’s in charge of preadmission screening?Using correct admission source
15LTC INELIGIBLE INFO Checking MNITS eligibility Form 3543 Ineligible Recipient has been found to be ineligible for LTC/Waivered services---work with county/AREP to determine length of ineligibilityUndeterminedEligibility determination is not yet completed by county
16LONG TERM CARE INSURANCE Increase in the # of policiesInfo listed on MNITS Elig Screen as policy type 27 or 13Insurance is not counted as spenddownMust be able to support the use of the 24 occurrence codeIns. Payments must be reported on claimsHave payments come directly to the facilitySee attached statute language
17NON-PAYMENT Find out why If MA denial, contact help desk first Contact Responsible Party/RepresentativeWho else receives or should receive the bills?Insurance Denial/Appeal
18UNRESOLVED NON-PAYMENT ISSUES Meet with Family, Resident and any other Interested PartyNotify Adult Protection if financial exploitationDHS BulletinIssue Discharge Notice30 days and sometimes lessDemand Letter to Begin Legal ProcessHardship Considerations
19UNRESOLVED NON-PAYMENT ISSUES Conservator (get one and/or remove one)Probate EstateLawsuitCriminal Restitution ClaimsDishonored ChecksEncourage your client to take control – if possibleVulnerable adult victim of financial exploitation can now sue for 3 times their damages and costs.
20TOP 10 BILLING ERRORS FOR MA RECIPIENTS Casemix MissingThird Party Liability (Insurance)Pre Admission ScreeningPMAP/MSHORecipient Ineligible**form 3543**Claim Beyond Filing LimitLeave Days Not Allowed – Occupancy RateDischarge Date/Living ArrangementDuplicate Submission1503 Not Received/Entered By County
21KEEP TRACK OF AGING BALANCES Review of accountsWorking oldest to newest to avoid timely filing errorsAR meetings at least every 3-5 weeksResponsibility for follow upWho’s in charge of MDS?Who’s in charge of Preadmission Screening?Who determines Payor Source(s)?
22LTC POLICY AND PROCEDURES REVIEW Thank You!Greg LeahyProgram AdministratorNursing Facility Rates & PolicyMinnesota Department of Human Services(651)Robert Rodè, Esq.Voigt, Klegon & Rodè, LLC(651)