P-3314 Changes to accommodate the New York Medicaid Rate Code 3836 for the 6% additional reimbursement.

MODULE:        AR
PROGRAM:       POSTRBCH
AUTHOR:        BW/HZ 
DATE:          July 3, 2002


Medicaid Billing for Rate Code 3836

As you are aware, legislation establishing a six percent assessment on nursing home revenues was recently enacted. New York State Medicaid subsequently established a reimbursement mechanism that allows facilities to bill Medicaid to recoup a portion of that six percent assessment. The method by which this is done is to transmit a charge for code 3836 in addition to your regular weekly billing of Medicaid charges. This add-on can be billed for service dates beginning April 1, 2002.

The first time in July that you bill for the 6% add-on you will need to do the set-up as listed in steps 1 to 3 below, and to run the new program in step 4 below to have the system calculate the add-on charges retroactive from 4/1/02 to 6/30/02. On all future billing you will do your room and board postings as usual and you will see two lines for each charge: the regular Medicaid charge and the 6% add-on.  

This documentation is divided into six sections as follows:

1. Set User Parameters - Options Screen II

Log on to CHARTS. Type NHOP2 or [GM, 17, 13] and press ENTER. The following screen appears:

At Field #41, Separate Bill 3836 type Y

At Field #42, Contractual 3836 type either M or L based on how you would like to calculate the contractual allowance.

Option M is recommended by Martin Friedman & Co.

Option L is recommended by Jesse Frommer of Loeb and Troper.

Assuming a private room and board rate of $300 per day, a Medicaid room and board rate of $200 per day, and an add-on 3836 rate of $20 per day, the two options would produce the following results:

2. Setting up a Bill Type for the NYS Medicaid add-on

Log on to CHARTS. Type CTF [GM, 15, 2] and press ENTER.

Type 1 for Census Control, press ENTER, and then type 1 for Billing Types and press ENTER.

At Enter Main Key type your Medicaid code, usually 11 and press ENTER. The following screen appears:

The only field that should be modified is NY Reimburse. Bill/Rate Code in the bottom left of your screen. In that field type the Main Key of the new billing type that you will use for the NYS Medicaid Add On, which in our illustration is 19. Any unused billing code number may be used.

Please note that if you have more than one Medicaid bill type (e.g., Vent or HIV) you will need to modify each Medicaid Bill Type record to insert (as in our illustration) the NY Reimbursement, Bill/Rate Code of 19. 

Next, add the new NYS Medicaid Billing Type:

Type ATF [GM, 15, 1] and press ENTER.

Type 1 for Census Control and press ENTER.

Type 1 for Billing Types and press ENTER. The following screen appears:

At Enter Main Key type in the code for the NYS Medicaid Assessment Add On, in our example 19. At Secondary Key type NYS and press ENTER.

The above screen should be completed identically to the regular Medicaid Billing Code table as set up on your system (Main Key # 11 in our example). The only differences are the following:

3. Setting the 3836 Rate Code

Type ATF [GM, 15, 1] and press ENTER.

Type 8 for Accounts Receivable and press ENTER.

Type 12 for Rates and Dates,and press ENTER.

Type the Code as 25 (or any other unused rate code) and the Year as 02 and press ENTER.

Complete the screen as below: at Monthly/Daily type D, At Description type RATE FOR MA ADD ON, supply your facility’s add on rate under Rate,  and at Date type 04/01/02, and press ENTER.

Even if your facility has multiple Medicaid Bill Types you only need to create 1 Rates and Dates record.

4. Creating AR Charges for the Add On from April 1, 2002 until today

The legislation allows for a nursing facility to back bill for the add on from April 1, 2002. CHARTS has created a simple procedure to accomplish this.

Log on to CHARTS.

Type CODE3836 or [GM, 8, 2, 15] to Create NYS 3836 Add On Charges and press ENTER.

The following screen appears:

Select Medicaid by marking it with an X and press ENTER.

In our example we bill be back billing from April 1, 2002 thru June 30, 2002. The add on rate should appear correctly initialized to your facility’s rate. If no rate appears or an incorrect rate appears then you have made a mistake in the rate set up, please review those steps or call client services.

The next screen will appear and the to date and posting date should be entered.

First a preliminary listing should be run (List/Post = L) and reviewed. Afterwards run the program again and specify List/Post = P.

5. Creating a File to Send to Medicaid

These steps are identical to a regular billing cycle. Run the NYBILLS program [GM, 8, 3, 2, 1] specifying N to process current charges and Y to process outstanding charges. In the Outstanding Charges box type the service dates as 04/01/2002 thru 06/30/2002 based on our example.

Afterwards, run the CR8TAPE program [GM, 8, 3, 2, 2] as you would for a regular billing to create the file to be sent to Medicaid.

The above outlined steps need to be performed only once. On an ongoing basis whenever Room and Board Charges are created the charge for the NYS add on will also be created and two detail billing lines will be sent to Medicaid. There is no additional user intervention required. When the cash remittance is received two items will be paid: the regular R & B charge and the NYS Add On.

The Post Individual Charge program [GM, 8, 2, 5] has also been modified to create two charge lines for all items posted with a service date of April 1, 2002 or later.

The Bill Outstanding Receivables program [GM, 8, 2, 4] has been modified so that when the R&B Medicaid Receivable is marked as billable, the NYS Assessment Charge will also be marked as billable. This does not apply if the original R&B claim is an adjustment record type.

The AR Void program [GM, 8, 6] has been modified to void the NYS Assessment Charge record when voiding the original R&B record.

6. Programs and Pages included in this release (For RHS use only)

Pages:
M1HD
M1F1 - M1FZ
M182
M182F
M1825
M18601