State Medicaid programs will reimburse hospice agencies 95% of the room and board costs they incur for treating eligible Medicaid patients in nursing facilities. It would be simple if the nursing facilities could bill Medicaid directly for these costs? Unfortunately, it does not work that way. The hospice agency is responsible for paying the nursing facility for the room and board of their Medicaid eligible hospice patients. It is up to the agency to gather the necessary information from each of the nursing facilities and to assemble that information into a bill to send to Medicaid to receive reimbursement for part of their room and board expenses. These facilities each have their own daily room rate so billing is not standardized. Patient spend-down or responsibility requirements vary from patient to patient. Often times it takes weeks for the facility to send a bill to the hospice agency and when they do send their bill, they don’t send it to the biller at the hospice agency. Instead, they send it to the attention of the accounts payable department at the agency.
Healthcare Provider Solutions (HPS) once did the billing for a multi branch hospice agency whose accounts payable department was receiving and paying these invoices without ever forwarding these invoices to HPS for secondary billing to Medicaid. Fortunately this state Medicaid program had a generous timely filing deadline and HPS was able to identify this problem and work with the agency to get invoice copies and get the claims billed to Medicaid. Needless to say, when this agency realized that they nearly left thousands of dollars on the table they implemented a sound process to get these facility invoices to the HPS billing department promptly.
If your hospice agency is treating Medicaid eligible patients in nursing facilities then your biller is probably struggling to keep up with Medicaid room and board billing. The key to success in this arena, according to the lead hospice billing consultant at Healthcare Provider Solutions, is to develop relationships with each of the facilities your agency deals with and to take a proactive approach to billing.
The hospice agency billing department should develop contacts with each of the facilities they work with. The biller should know the daily rate for each facility and patient responsibility or spend down amount for each patient.
Healthcare Provider Solutions suggests instead of waiting for the facility to prepare and send room and board invoices that instead, armed with the information above, the hospice agency prepare the invoice and send it to the facility for approval. If the daily rates and applicable spend down amounts on the invoice are correct the facility can approve the invoice, return it to the hospice agency and the biller can get the invoice to the agency accounts payable department for processing and promptly bill Medicaid for room and board reimbursement.