Thank you for your input!
Jo Ann Girtz
Supervisor Patient Financial Services
CHI Health at Home – Home Health and Hospice
4816 Amber Valley Parkway
Fargo, ND 58104-8404
Phone (701) 237-8133 / Fax (701) 237-8188
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From: list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Hotvedt, Steve W
Sent: Friday, March 11, 2016 1:16 PM
To: billers@list.mnhomecare.org
Subject: RE: MN Medicaid Room and Board - Hospice billing
At Healthpartners Hospice we pay the SNF’s exactly what MA pays as the billed amount frequently differs from the paid amount due to case mix, spenddown changes,
etc. We deal with SNF disputes on this by adjusting claims if the SNF has good reason to believe their rate/spenddown is correct. We put the burden of correction on the SNF as the claim is still theirs, and we are the proxy submitter. To take on the burden
of that as the hospice, would be beyond our ability to handle given the volume of claims and problems.
We pay 100% of the paid amount to the SNF and absorb the 5% skim off the top by MA.
Unfortunately due to the size of my organization, the claims process is split between me and corporate check processing which means that I submit the claim,
mark it up accordingly due to the actual payment amount and send it on to check processing. We do not share databases and because of a poor software application, I track the progress of claims using a home-made x-cel spreadsheet, and often have to refer
detailed payment info to the other department when questioned by snf’s.
Another aspect of our process is that we require UB claims requiring exacting standards in providing information in the required fields and processed according
to HIPAA standards. This slows the process down as many snf’s make mistakes on their claims that due to volume, are impossible to catch them all resulting in some denied claims.
I would recommend to anyone else in my position that it would be faster and more accurate to have the whole process performed in one place by the same person
and accepting billing protocol that provides essentially correct information but not adjudicating in such a way that a non-essential data points cause denials.
Hope that helps.
From:
list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Girtz, JoAnn
Sent: Friday, March 11, 2016 11:48 AM
To: billers@list.mnhomecare.org
Subject: RE: MN Medicaid Room and Board - Hospice billing
What are some of the process you have for billing MN Medicaid Room and Board?
Because of the time frame of billing, reimbursement and month end processing how is this managed smoothly and reconciled?
Do you pay the facilities the 95% rate that is reimbursed or 100% of the case mix rate?
I am trying to put together a process as what we have in place is quite cumbersome and not manageable.
Any ideas, suggestions would be helpful.
Thanks.
Jo Ann Girtz
Supervisor Patient Financial Services
CHI Health at Home – Home Health and Hospice
4816 Amber Valley Parkway
Fargo, ND 58104-8404
Phone (701) 237-8133 / Fax (701) 237-8188
The information contained in this electronic mail communication and the accompanying pages and/or attachments is intended solely for the use of the addressee.
Unauthorized use, disclosure, distribution, or copying is strictly prohibited and may be unlawful. The information contained in this document is highly confidential and may be subject to legally enforceable privileges. If you have received this communication
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