Medicaid
Valid Auth Rep Signers
Resident, Guardian, Financial POA, NOT SPOUSE!
Frequency of Spend Down Letters, for whom?
Monthly, Anyone with $1,800 or more in their PNA
I need a new insurance added, I should....
Send oliver the new insurance form, with details on where I need this added. Included payer and billing address.
Items due day 1 of close
Balanced census, PA1 report, Private Room Incentive, Optum Transport Log, VA triple check
Mandatory UR Participants
BOM, DON, Therapy, MDS, Admin, Social Services. Who is helpful to add?
Special Income Limit for 2025?
300% of the SSI Rate - $2,901
I can issue a check when...
It's in my vendor tab to "pay vendor"
I got returned statements, I should....
Call for an updated address, look for obituary, NOT DELETE address.
5th date of the month. NOT business days
NOMNC for my Community MCD....
discharge home safely, if ABD disenroll. What do we do if CFC and no home?
My Medicaid Log is Due....
Friday by 5pm
A signed trust auth is valid when...
Resident or responsible part signs with 1 witness that is not a staff member. If not legible, 2 witness are needed.
What do you do prior to generating statements?
Post Cash, generate, review for missing primary billing contact
Mandatory Triple Check Staff Members
Admin, DON, BOM, MDS, DOR. Who is helpful to attend?
Information BOM provides in UR
Benefit Verification, # of days, Reimbursement, Copays, Financial Roadblocks
Bobby received a $50k inheritance payment
Reports payment to Medicaid, purchases a funeral, purchases items needed for his care/comfort, disenrolls from Medicaid and private pays. If Bobby disagrees - return funds all to Medicaid. Boo :(
I can close an account when....
within 30 days, valid funeral statement, to spouse, Estate Recovery.
My auth & my census don't match
Can I reschedule triple check? What is a team member is on vacation?
Regional support must be able to attend on the rescheduled date. Must be approved by Katherine - directly affects your claim payment.
Correct DOS, Accurate Auth #, Correct Payer, DX Codes, QHS, Assessment
My Application was DENIED!!
Email RBOM & Ranee to review jointly. Review eligibility, note appeal deadline, spend down to facility, USE YOUR DAR!!!!
Who signs my quarterly statements?
Legal Rep Payee - Direct Deposit Name Report
Admin - if facility payee
Residents - ALWAYS if they are alert!!!!!
Nothing is uploaded for my new admissions
DON'T UPDATE THE CENSUS!
When do I send my TC sheets?
All ERRORS are corrected, all MDS are done, all items are verified. NO FURTHER CHANGES TO BE MADE.
6 type of Reimbursement Structures
PDPM, RUGS, Levels, Episodic, Capitated, Per Diem