Kansas
True or False: When completing a KS NICU Institutionalized MCD application, I do not need to complete a PMDT or pursue Disability.
True.
True or False: A MO supplement form should be completed online after the application and also uploaded to the MO portal for processing.
True.
True or False: A pt does not need work credits to qualify for the SSI program.
True
When explaining SOBRA to a patient, should we let the patient know that their full hospital stay will be covered?
No, we want to let the patient know that only emergency/life threatening/limb saving services are covered and that it is determined by the state.
What effective dates do you use to make a Medicaid Pending plan ineffective and remove from the patient’s account?
1/1/1900 – 1/1/1900
17-year-old Jesse recently gave birth to a baby boy. Jesse and the newborn will live with her mother Joan, for the next year. Joan also has two other dependents in the home, both already having KS Family Medicaid. Who would be considered head of household ? Would we need to start a new application for Jesse and the newborn ?
Joan would be considered head of household since Jesse is under 18. Elevate can submit an Add newborn form to Kancare to request coverage for the new baby.
True or False: For MO institutionalized NICU MCD, I do not need to complete an MRT or pursue disability.
False, MO requires an MRT and a DA bundle.
False, since she is over 65, Nora would still need to provide proof of social security filing.
If a patient reports they are undocumented, what 3 additional things should you ask if they have?
LPR, work permit, ITIN
When returning or certifying an account in Epic, how do you remove the outsource agency code?
Account activities – 124 – copy/paste your note
Pamela is a single 70-year-old female. Pamela will be discharging to a long-term care facility, however, she owns her home, which makes her ineligible for KS LTC coverage. She will have to sell her home for LTC eligibility. What verifications do we need to send Medicaid and how long does the patient have to sell their home?
We will need proof of intent to sell her home, this could be a screenshot of her home being listed on Zillow, a picture of a for sale sign in front of the home, etc. Patient has up to 1 year to finalize the sell.
Your patient is currently a MO resident but was born in New York. We will be pursuing expansion Medicaid on the patient's behalf. Other than proof of income, what other document would we need to request from the patient?
Birth certificate is required for all pts applying for MO Medicaid that was not born in MO.
Elevate screened 64-year-old Steve and he states that he is currently receiving $1000/monthly from his KPERS pension and also receives social security benefit of $895/monthly. What additional information does Elevate need from the pt to proceed with filing for Medicaid ?
Elevate would need to follow up to determine what kind of SSA benefits the pt is receiving, since this benefit could possibly be early retirement.
What is an ITIN and how can the hospital having this number benefit our patients?
Bonus question (+400): If there is an ITIN, where in advocate would you put this information ?
ITIN (Individual taxpayer identification number). It is important to ask our undocumented patients for their ITINs so the hospital FCs can assist them with applying for potential ACA insurance that can cover ongoing medical expenses.
'Billing' Tab, under 'business code'
After updating the effective dates, what are the correct steps in Epic to undo billing from Pending coverage and remove from the account?
Liability Bucket – click ‘1’ or ‘2’ box next to Pending coverage plan – click undo billing – go back to Coverages tab and click ‘remove’
Ella is a 75-year-old female that was recently in a terrible car accident. She is now needing to discharge to a long-term care facility due to her husband not being able to care for her while at home. The couple owns their home, a vehicle and also has a whole life insurance policy with a CSV of $50,000. What program should we be pursuing? Would the patient need to deplete?
KS ABD MCD (LTC), we could request division of assets so pt would not need to deplete.
Evette has a new end stage renal disease diagnosis and is needing ongoing dialysis, however, she is uninsured. She is unemployed and does not receive any income. She recently received her mom's life insurance payout of $50,000, which puts her over the resource limit for MO ABD MCD. Does this make pt completely ineligible for MO MCD ? Why or why not ?
No, Elevate could assist Evette with applying for expansion Medicaid while she works on depleting her resources. Once that is completed, she could upgrade her coverage to MO ABD MCD.
Elevate has screened Teresea eligible for KS ABD MCD. Teresea shared that she is a LPR of 5 years, however, she has not worked five of the last ten years. Would Elevate still need to pursue disability ?
Yes, if eligible for KS ABD MCD, the patient will still need to provide proof of social security filing. Elevate can assist with courtesy filings.
True or False: Patients born in Micronesia would automatically qualify for SOBRA coverage, income/resources are not counted and pt does not need to meet Medicaid requirements (Aged/blind/disabled/family).
Bonus question (+400): What additional documents should we be requesting from Micronesia patients?
Double Bonus question (+800): Name the 4 Micronesia states!
False, Micronesia patients would still need to meet basic Medicaid criteria and would then qualify for permanent Medicaid coverage instead of Sobra.
I-94
Chuuk, Pohnpei , Yap, Kosrae.
When certifying an account in Epic, what 2 billing indicators should you always remove and what billing indicator should you always add?
Remove: MedData Eligibility or Secondary & Account Has Been Pending Medicaid; Add: MedData Eligibility Certify or MedData Secondary Certify