Current status of rebase rates
for nursing facilities and home health

NF Rebase

  • Rate Increase- Most providers have seen payments begin processing for facilities who have been notified of rate increases back to 7/1/17.
  • UnitedHealthcare- claims will be reprocessing automatically, no matter what the provider billed.
  • Amerigroup-if what the provider billed is less than what their new rate is the provider will need to submit a corrected claim for the amount of their new rate or a customary charge rate that would be higher than the Medicaid rate.
  • AmeriHealth- if what the provider billed is less than what their new rate is the provider will need to submit a corrected claim for the amount of their new rate or a customary charge rate that would be higher than the Medicaid rate.
  • Rate Decrease-
  • UnitedHealthcare- mentioned that they wanted to complete all the rate increases prior to processing the rate decreases. IHCA initially approached UHC about payment plan arrangements when we projected rebase estimates. Gathering contact information for those providers who would be requesting a payment plan was a solution that was presented and ultimately decided on. We knew we were working in a tight window of time as some of the down adjustment of rates had been entered. We have been notified from some providers that the decreases have started reprocessing. If you were not included in the initial list of providers who were requesting a payment plan from United, reach out to your provider advocate if your claims have not been reprocessed yet.
  • Amerigroup if providers have questions regarding the recoupment of claims or offsetting of overpayments against future claims they are encouraged to reach out to their provider relations consultant to determine an appropriate payback method.
  • AmeriHealth Caritas, the rates configuration have been almost completed. Providers should receive a letter from AmeriHealth with instructions and contact information should they have any concerns or questions.

Home Health Rebase

There has been some confusion with implementation of the rates because of the original file that DHS sent on December 12, which consisted of all rate decreases and the correction the came out on February 5th, which had both increases and decreases depending on the metropolitan area. The December 12 rates, with all decreases, were implemented pretty quickly by the MCO’s and some future claims were processed at this rate going forward. It is possible if the rate decrease from December was entered by the MCO, the provider may see a correction to the December amount and then a correction again to the February amount.

1

  • Rate Increase-
  • UnitedHealthcare- claims will be reprocessed automatically, no matter what rate the provider billed.
  • Amerigroup- if what the provider billed is less than what their new rate is the provider will need to submit a corrected claim for the amount of their new rate.
  • AmeriHealth Caritas- the rates are being loaded and should be completed by the end of March and reprocessed by mid-April. If you have seen some payments recouped at the incorrect rate wait until the April remits have reprocessed and see if those get you the correct payment. If what the provider billed is less than what their new rate is the provider will need to submit a corrected claim for the amount of their new rate
  • Rate Decrease-
  • UnitedHealthcare- if the provider has a concern about the recoupment they can reach out to their provider advocate to enter into a repayment plan. Providers should receive a letter from UHC detailing the decrease in rates the provider will be experiencing.
  • Amerigroup- they will automatically reprocess those claims at the lower rate.
  • AmeriHealth- if after the final updates are in place and there is a recoupment, providers should receive a letter from AmeriHealth with directions set forth in that that recovery letter on how to proceed if they have any concerns or questions regarding the payback.

1