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01/09/2019

Mass Adjustment for Hospice Claims Results in Recoupment

In December, the Ohio Department of Medicaid (ODM) began to process mass adjustments to hospice routine home care level of care claims where Medicaid was the primary payer; they are looking back to January 1, 2016 in this work. The adjustments affect two-tiered routine home care and SIA payments that had not been paid correctly by ODM previously.

LeadingAge Ohio has received some “911 calls” regarding some of these adjustments as Medicaid has recouped significant amounts of money in certain instances. Some claims have had recoupment of all routine home care payments back to January 1, 2016. In researching this particular issue, the hospice remittance advice noted that the hospices had not enrolled their routine home care patients into MITS dating back to January 2016, which was the reason for the recoupment.

LeadingAge Ohio reached out to ODM staff to see if there was any recourse for the hospice provider to be reimbursed for services, even those as far back as January 2016. ODM shared that the one-year timely filing requirement has temporarily been lifted for these claims. ODM said that providers can still enroll their routine home care patients into MITS back to their first enrollment date. Once the enrollment is accepted, providers can then rebill the claims for those patients.

LeadingAge Ohio recommends that all hospice providers review their ODM mass adjustment remittance advices closely to:

  • make sure all Medicaid primary routine home care patients are entered into MITS with dates of service back to January 2016, even if those patients died in 2016.
  • ensure that the two-tiered routine home care and SIA adjustments are correct for all Medicaid primary routine home care claims.

If you have any questions regarding your ODM mass adjustment remittance advice, please don’t hesitate to reach out to Anne Shelley at ashelley@leadingageohio.org.

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.