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Friday, October 11, 2024, 12:02 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
NURSING HOME

Can you add beneficiaries or other information to the TAD for me?

No, MCCS staff cannot add any information to the TAD. You can only make changes via DHHS Form 181, CRCF 01 and IPC change forms.

Can you assist with Medicaid/bed hold billing procedures?

An authorized SNF 181 along with a separate Medicare-to-Medicaid bed hold billing 181 is required.

Can you correct the 181/CRCF-01 form?

No. MCCS staff cannot make corrections to the DHHS Form 181 or CRCF 01 form.

Does the Nursing Facility (NF), Intermediate Care Facility (ICF) / Mental Retardation (MR) or Swing Bed facility have to wait for a denial from DHHS before submitting an invoice to the hospice agency?

Yes. The denial must be attached.

I did not receive my TAD. Can you fax/mail a copy?

MCCS can send a copy of the TAD when requested.

Is an eligibility signature required for termination? (Nursing Home)

No signature is required for terminations.

Is the date of discharge for Nursing Facilities or Intermediate Care Facility (ICF) / Mental Retardation (MR) room and board Medicaid reimbursable?

Nursing Facilities and ICFs/MR are not reimbursed for the date of discharge.

Nursing Facilities and ICFs/MR should not invoice hospice agencies for the date of discharge. The date of hospice discharge for a reason other than death or transfer to another facility is billed to Medicaid.

For example: If the person was in an NF or ICF/MR facility from Feb. 1 to Feb. 23, 2013, and was enrolled in hospice from Feb. 1 to Feb. 14, 2013, the hospice would pay NF or ICF/MR the room and board for Feb. 1 to Feb. 13, 2013. Medicaid would pay the NF or ICF/MR for dates of service from Feb. 14 to Feb. 22, 2013. 

Should claims returned on Form 017 or 017CI without processing be re-filed?

Yes. Once corrections are made, Medicaid claims should be re-billed using the CRCF-01 form for OSS and the DHHS 181 for NFs. Coinsurance claims can be submitted at any time of the month once corrections are made.

What happens if my DHHS Form 181, CRCF 01 or IPC form is not received on time or is not received at all?

No changes will be made regarding beneficiaries’ income, IPC/CRCF status, etc., for the current billing month if change forms are not received by MCCS. However, changes can be made during the next month’s billing process.

What happens if the NF or ICF/MR* accepts a hospice resident while Medicaid eligibility is pending and it is later determined that the resident is not eligible? Who is responsible for room and board payment to the NF or ICF/MR?

The hospice is responsible for the room and board amount.

It is imperative that the hospice social worker continues to pursue eligibility for the resident to decrease the financial risk in the event the resident is ultimately not eligible for nursing facility benefits. 

*Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR)