Learning Resources
Frequently Asked Questions
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When are TADs available for providers to view on the Web Tool? | |
What happens if the Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR) is paid in error for hospice dates of service?The nursing facility must submit a request for an adjustment. The adjustment process must be completed before the hospice can be paid for room and board dates of service. | |
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) | |
Who is responsible for pharmaceutical costs as it relates to the terminal illness?The hospice agency is responsible for pharmaceutical costs related to pain management and symptom control of the terminal illness. | |
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. | |
Will the hospice agency receive a copy of the DHHS Form 181 when the recurring income changes?Yes, they will receive a copy of the 181 to verify the income change. It is recommended that the NF or ICF/MR attach a copy of the most current 181 when invoicing the hospice. Recurring income is noted in Section III of DHHS Form 181. Medicaid Eligibility is responsible for determining recurring income. | |
Will every Nursing Facility or Intermediate Care Facility (ICF) / Mental Retardation (MR) have the same rate?No. | |
What happens if my DHHS Form 181, CRCF 01 or IPC form is not received on time or is not received at all? | |
Why would a Nursing Facility provider receive a 951 rejection if the beneficiary had always been eligible for NF Medicaid since entering the facility?A 951 Edit Code means the beneficiary was not eligible for Medicaid on the date of service. The beneficiary and/or responsible party for the beneficiary might not have completed the annual Medicaid eligibility review. Inform the nursing facility caller to contact the beneficiary’s eligibility caseworker. | |