Q&A session for LTC Nursing Faci1ity/Hospice Webinar
session number: 798533574
Date: Wednesday, April 21, 2010
Starting time: 8:21 AM

Q: If assessments were transmitted late, because a new facility did not have information (NPI number, log -in, etc.) to transmit, does this effect payment?

A. Yes; this would affect payment. Everything has to be in order; the NPI must be in section W of the MDS assessment otherwise TMHP would not extract the assessment onto our LTC Online Portal; you would have to have your administrator or user log in id; otherwise you would not be able to access the secure LTC Online Portal to submit forms and retrieve assessments. The appropriate forms & assessments would not be submitted, therefore you would not have authorization & could not bill for services.

Q: We are a new facility (opened 4/1/10) currently we have 3 patients and do not have provider numbers, will we the facility be penalized for not submitting information?

A. In order for you to open a new facility & bill for Medicaid clients, you would have to be licensed by DADS & enrolled by DADS & issued a contract number. Without a contract number, you would not be able to submit forms/assessments or bill for services.

Q: I am admitting a patient with a history of mood disorder or schizophrenia does that automatically mean a PA5ARR must be completed? The RAI manual States psychiatric issue, functional limitations arid history of disruption to be considered an issue.

A. Refer to TAC 19.2500 regarding PASARR requirements as well as our LTC Programs home page on tmhp.com & the PASARR screening instructions are available.

Q: What is the deadline to submit co—insurance claim? HOW do we file a claim if patient is out of days and has part B only? We are a hospital base SNF facility that bills for MCR co—insurance stays for MCR patients.

A. Remember, Part B is not handled under your LTC provider #; Part A is handled under your LTC provider #. Part B is billed using your Acute Care TPI. The deadline for submitting Part A is with 72 hours of the transaction date on the 21st day on the 3619 form after meeting the 20 qualifying days. Remember about the repercussions of submitting the forms late & also remember to distinguish between Part A & Part B Medicare co-insurance.

Q: If the patient has utilized all 100 days of the SNF Medicare Benefits, and they have Medicaid, how would we bill Medicaid beginning with day 1O1?

A. You would submit a 3619 discharge on the 101st day & a 3618 admit on the same day admitting the resident to full Medicaid; at that time, the LTC Online Portal will extract the most recent MDS and place it in “Awaiting LTC Medicaid Information” & the provider would search FSI & complete LTCMI & submit successfully & then this will start the MN process.

Q: How does late transmission effect payment?

A. It was announced in the webinar that these questions regarding late assessments were entered prior to the section covering the PC E & PC M & if they still were unclear after this portion of the presentation was presented, to please submit another question & this question as well as the one below would be answered at the formal q & a at the end of the presentation.

Q: If an assessment is completed late, and we expect to be paid default rate for late assessment would you complete LTCMI or complete purpose code? And which purpose code?

Q: When you say “completed assessment” in regards to missed assessment that require an E, isthe completion of the LTCMI a part of that “completed assessment? If so, where in the TAC code is it stated that the LTCMI must be done within that same 92 days?

A: The assessment is not considered complete until the LTCMI has been successfully submitted; I would also like to refer you to TAC 40 19.2413 noted in your participant guide on page 60.

Q: How does a new facility find out what “level we are assigned?
A: Check MESAV

Q: Who determines and how is it determined the initial Medicaid eligibility date on a P” status on the MESAV?
A. The ME worker determines eligibility not TMHP. HHSC’s Office of Eligibility Services (OES).

Q: If a PVT pay long term resident applied For Medicaid in February and is due for a quarterly -in May what assessments would need to be done to get the resident approved for Medicaid and to receive retroactive payments?

A. This is really a 2 part answer; Remember the MDS cycle should be adhered to regardless of payor source; once a privatepay resident transitions to full Medicaid; submit form 3618 admit within 72 hours of transaction date & this will trigger the LTC Online Portal to extract the most recent MDS; then you will have to search FSI or Current Activity for your assessment with the status of “Awaiting LTC Medicaid Information”; once this has been successfully submitted, this will start the MN process. The second part of the question regarding retroactive payments; this is the determination of the ME worker whether or not the resident qualifies for retroactive eligibility & you will access the MESAV to check for the “P”; not all resident’s are made retroactive depending on certain criteria.
Q If a resident without PMN begins a Medicaid stay and that stay is interrupted by a hospital and subsequent MRA stay does the 184 calendar days keep counting or is the count interrupted by those days when the resident is not in the Medicaid?

A. This must be a consecutive 184 days due to the resident could come & go to the hospital without ever having established permanent medical necessity.

Q If you inactivate a child’ form because the parent form was actually the correct form, does the parent form then become the active form or is the parent form inactivated as well?

A.If you incorrectly inactivate a child form (which is the corrected form) you cannot go back & use the parent form because this form is not in use anymore since you corrected it. You will have to submit a new form.