Home Health and Hospice

Transcription

1 Home Health and Hospice

2 Overview Eligibility Fee Schedule Prior Authorizations Resources Enrollment 2

3 Eligibility

4 Participant Eligibility Why should you check eligibility? To verify a participant has Medicaid coverage on actual date of service To review a participant s eligibility plan and coverage codes Note: Medicaid card does not guarantee current Medicaid coverage. 4

5 Verifying Eligibility Three ways to check eligibility: MACS Medicaid Automated Customer Service 1(866) HIPAA compliant vendor software Health PAS-OnLine Trading Partner To obtain eligibility information from one of these systems, submit two pieces of identifying information from the following list: Medicaid ID number (ten digits) Social Security Number (SSN) Last Name, First Name Date of Birth 5

6 Navigating the Secure Portal 6

7 Patient Roster 7

8 Patient Roster Build Roster Two pieces of identifying information required; MID and DOB recommended 8

9 Patient Roster Actions 9

10 Verifying Eligibility Two pieces of identifying information required 10

11 Verifying Eligibility 11

12 Verifying Eligibility 12

13 Coverage Medicaid offers several coverages that are aligned with health needs and include an emphasis on prevention and wellness. Coverage codes: Basic Coverage Enhanced Coverage (includes Katie Beckett) Pregnant Women Coverage (PW) Medicare Co-insurance & Deductible (QMB) Part B Premium Coverage (SLMB) MMCP Coverage 13

14 Basic Coverage The Medicaid Basic Coverage type is for healthy, lowincome children, and adults with eligible dependent children. Provides complete health, prevention, and wellness Note: Most Medicaid participants will be enrolled with this coverage type. Visit for list of detailed services covered by each Medicaid plan. 14

15 Basic Coverage Example 15

16 Enhanced Coverage The Medicaid Enhanced Coverage type is for participants with disabilities or special health needs. Includes all benefits in Basic Coverage, plus additional benefits: o Nursing Facility o Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) o Private Duty Nursing o Home & Community Based Waiver Services o Service Coordination Many of the services in this plan have medical eligibility and prior authorization requirements 16

17 Enhanced Coverage Example 17

18 Pregnant Women Program The Pregnant Women (PW) program is for pregnancy-related services only. This coverage ends on the last day of the month in which the 60 th day after delivery occurs Women have access to prenatal and postpartum care, including: o Normal prenatal services o Nutrition counseling o Risk reduction follow-up o Social service counseling o Chiropractic and physical therapy services o Family planning, including sterilization w/consent o Dental coverage 18

19 Pregnant Women Program Example 19

20 Medicaid and Medicare Not everyone qualifies for regular Medicaid, but they may be eligible for Qualified Medicare Beneficiary (QMB) programs where Medicaid helps pay for Medicare costs including: Monthly Medicare premiums Medicare co-insurance Medicare deductibles 20

21 QMB Example 21

22 Specified Low-Income Medicare Beneficiary Coverage What expenses does SLMB cover? Specified Low-Income Medicare Beneficiary (SLMB) Medicare Part B premium only Note: No Medicaid coverage for services. 22

23 SLMB Example 23

24 Medicare and Medicaid Eligible What expenses are covered for participants who are fully eligible for both Medicare and Medicaid? Medicare covered services Medicaid covered services 24

25 Medicare and Medicaid Eligible Example 25

26 Medicare-Medicaid Coordinated Plan The Medicare-Medicaid Coordinated Plan (MMCP) is for participants who are 21 years old or older, enrolled in Medicare Part A and Part B, eligible for full Medicaid, and reside in an MMCP coverage area. Participants voluntarily enroll in MMCP. Currently there are two MMCP programs; one offered administered by Blue Cross of Idaho, and one administered by Molina Healthcare. Note: Once a participant is on MMCP, they can choose to revert back to Medicare and Medicaid individually. 26

27 MMCP Example 27

28 Home Health

29 Home Health Medicaid covered services include: Skilled nursing Home Health aide Physical, occupational, and speech-language pathology therapies Durable Medical Equipment Idaho requires that all enrolled home health agencies are first enrolled with Medicare. Note: All home health services are provided in the participant s residence. 29

30 Home Health Refer to the Provider Handbook - Agency Institutional for additional information to include but not limited to: Participant eligibility Limits Prior authorizations Plan of Care Medical equipment and supplies 30

31 Hospice

32 Hospice Hospice agency is responsible for management and coordination of the Plan of Care Hospice agency is responsible to inform other providers the participant is eligible for hospice Participant may elect or revoke hospice services at any time during the benefit period. 32

33 Hospice Refer to the Provider Handbook - Agency Institutional for additional information to include but not limited to: Participant eligibility Hospice election and recertification Prior authorization for Skilled Nursing Room and Board Covered services and restrictions 33

34 Claim Submission

35 Claim Submission Methods Claims can be submitted under View & Submit Claims But today, we will show you how to submit claims through View Patient Roster. 35

36 Patient Roster Submit Claim 36

37 Claim Submission Institutional (UB04) Claim 37

38 Claim Submission Coordination of Benefits Note: After clicking Submit in the COB box, you must remember to click Submit on the claim form. 38

39 Fee Schedule

40 Fee Schedule 40

41 Fee Schedule 41

42 Home Health Fee Schedule 42

43 Hospice Fee Schedule 43

44 Authorizations

45 Authorization Status 45

46 Authorization Status Search 46

47 Authorization Details 47

48 Did You Know?

49 Announcements 49

50 Information Releases 50

51 Provider Handbook 51

52 Provider Handbook 52

53 Fee Schedules 53

54 Fee Schedules 54

55 MedicAide Newsletters 55

56 MedicAide Newsletters 56

57 User Guides 57

58 Training 58

59 Idaho Medicaid Training Center 59

60 Training Opportunities Monthly WebEx Trainings o o Available to all providers Calendar is located at Regional Workshops o o Yearly Information will be posted to Individual Training or Questions o Contact your local Provider Relations Consultant 60

61 Enrollment and Maintenance

62 Enrollment/Maintenance Be sure to keep your information up to date. o o o o o Current contact Mailing/W9/physical and addresses Adding and terming rendering providers Adding and terming service locations Change of ownership 62

63 Enrollment and Maintenance 63

64 Enrollment and Maintenance Forms 64

65 Provider Maintenance 65

66 Provider Maintenance Maintenance is required when any information changes: Physical, mailing, and address Add, term, update service locations Rendering or service provider changes Name changes Change in ownership Note: Contact updates are made through Maintenance Demographic. 66

67 Tips Use current forms Complete all sections of the form use N/A when appropriate Utilize the Provider Enrollment Requirements document in the Provider Handbook for type and specialty information, as well as additional requirements New W9 for 1099 changes W9 name and tax ID must match IRS records Update provider credentials (licenses, certifications, insurance, etc.) 67

68 Tips License Updates Updated Credentials: License As long as there are no changes to information, license updates are not required if you are licensed with the following: Idaho State Board of Nursing Idaho State Board of Medicine Idaho State Board of Pharmacy 68

69 Tips Provider Maintenance The Idaho Molina Medicaid website ( has the following resources: Provider Enrollment - Verifying Enrollment Application Status Provider Handbook User Guides Contact Molina at 1 (866) or idproviderenrollment@molinahealthcare.com for assistance with enrollment or maintenance 69

70 Provider Relations Consultants Region 1 and the state of Washington 1 (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1 (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 1 (208) Region.3@MolinaHealthCare.com Region 4 and all other states 1 (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 1 (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1 (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 1 (208) Region.7@MolinaHealthCare.com 70

71 Thank you for attending our Home Health & Hospice Training. Please take a few minutes to complete the evaluation. This provides us with valuable information for future trainings.