Presentation on theme: "LTC POLICY AND PROCEDURE REVIEW Greg Leahy Program Administrator Nursing Facility Rates & Policy Minnesota Department of Human Services (651) 431-2271."— Presentation transcript:
LTC POLICY AND PROCEDURE REVIEW Greg Leahy Program Administrator Nursing Facility Rates & Policy Minnesota Department of Human Services (651) Robert Rodè, Esq. Voigt, Klegon & Rodè, LLC (651)
Agenda Admissions Pre-admission screening Payment Responsibility Bed hold agreement Bedholds/Leave day billing Proactive billing LTC Eligibility LTC Insurance Other payment issues Questions/discussion?
ADMISSION AGREEMENT FORMS, POLICIES AND PROCEDURES Financial Information – You can ask for it Representative Payee Status Authorization for Release of Information for MA Assignment of Insurance Benefits Bed-hold Agreement - it’s a must have!
PREADMISSION SCREENING – WHY? Who Cares? You do! – Medical assistance denial of payment For a Medical Assistance recipient who has not had a pre-admission screening OR for services rendered prior to appropriate pre-admission screening For a Medical Assistance recipient who does not require nursing facility services – May not be able to bill private pay clients
PRE ADMISSION SCREENING – WHEN? PRIOR to or ON day of admission First working day after an emergency admission Within 40 days of admission if individual was admitted under a short-term exemption ALL residents Regardless of: Current living situation (i.e. hospital, community, etc.) Income, assets, and payor sources
Exception – Inter-facility transfers – Individual having entered into an acute care facility from a certified MN nursing facility is returning to the certified MN nursing facility – Individual is transferring from one a certified MN facility to another certified MN facility – These transfers are exempt because it is assumed the appropriate PAS occurred at the first facility admission PRE ADMISSION SCREENING – WHEN?
PRE ADMISSION SCREENING – WHO? Who is Responsible? Pre-admission screening – LTCC County social worker and/or public health nurse EXCEPT those enrolled in the following pre-paid Medical Assistance programs: Minnesota Senior Health Options Minnesota Senior Care Plus Minnesota Disability Health Options Level I LTCC intake team, county worker or public health nurse Level II Local mental health authority in the county where the person is seeking admission The professional seeking admission is responsible for ensuring the pre- admission screening is completed
PRE ADMISSION SCREENING – HOW? Telephone – A telephone screening is only allowed between two (2) health care professionals – Most typically used when a resident is seeking discharge from a hospital to a nursing facility Face-to-Face – All other screenings are to be done with a face-to- face meeting Watch for Under 65 and Under 21 Requirements
PAYMENT RESPONSIBILITY Check MNITS Eligibility Rep Payee Status—who is it? Authorization for release of information—get one signed!! – Counties may request this to give MA application updates
Will resident qualify for MA? – Direct family/resident to county financial worker – Briefly explain how MA works including spenddown – Choose your words carefully---MA elig is determined by the county – Explain that Medicare may pay up to 100 days— not all at 100% PAYMENT RESPONSIBILITY, CONT’D…
A 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; or – Not 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.
LEAVE DAY BILLING NF Eligibility – Facility must be above 93% occupancy – Rate reported with 24 value code and.93 Allowable Days per Resident – 18 consecutive hospital leave days Per each separate and distinct episode – 36 therapeutic days per calendar year Bed Hold Agreements
Allowable Payments – If NF at eligible occupancy level, provider paid 60% of RUG rate – Private pay is charged 60% as well – If NF below 93%, private pay can be charged up to 100% of RUG rate – MA recipients must be charged the same if they wish to hold the bed LEAVE DAYS CONT’D
PROACTIVE BILLING MNITS Eligibility MSHO/PMAP? NF liability days available? Hospice? Ineligible for LTC services?**(Form 3543) Spenddown? Preadmission Screening Knowing where recipient admitted from Who’s in charge of preadmission screening? Using correct admission source
LTC 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 ineligibility – Undetermined Eligibility determination is not yet completed by county
Increase in the # of policies Info listed on MNITS Elig Screen as policy type 27 or 13 Insurance is not counted as spenddown Must be able to support the use of the 24 occurrence code Ins. Payments must be reported on claims Have payments come directly to the facility – See attached statute language LONG TERM CARE INSURANCE
Find out why If MA denial, contact help desk first Contact Responsible Party/Representative Who else receives or should receive the bills? Insurance Denial/Appeal NON-PAYMENT
UNRESOLVED NON-PAYMENT ISSUES Meet with Family, Resident and any other Interested Party Notify Adult Protection if financial exploitation – DHS Bulletin Issue Discharge Notice – 30 days and sometimes less Demand Letter to Begin Legal Process Hardship Considerations
UNRESOLVED NON-PAYMENT ISSUES Conservator (get one and/or remove one) Probate Estate Lawsuit Criminal Restitution Claims Dishonored Checks Encourage your client to take control – if possible – Vulnerable adult victim of financial exploitation can now sue for 3 times their damages and costs.
Casemix Missing Third Party Liability (Insurance) Pre Admission Screening PMAP/MSHO Recipient Ineligible**form 3543** Claim Beyond Filing Limit Leave Days Not Allowed – Occupancy Rate Discharge Date/Living Arrangement Duplicate Submission 1503 Not Received/Entered By County TOP 10 BILLING ERRORS FOR MA RECIPIENTS
KEEP TRACK OF AGING BALANCES Review of accounts – Working oldest to newest to avoid timely filing errors – AR meetings at least every 3-5 weeks Responsibility for follow up – Who’s in charge of MDS? – Who’s in charge of Preadmission Screening? – Who determines Payor Source(s)?
LTC POLICY AND PROCEDURES REVIEW Thank You! Greg Leahy Program Administrator Nursing Facility Rates & Policy Minnesota Department of Human Services (651) Robert Rodè, Esq. Voigt, Klegon & Rodè, LLC (651)