June 24, 1996
Dear Client,
You may have received a letter from the State of New York DOH recently, informing you that effective June 1, 1996, hospitalization bed-holds between the 15th and the 20th day, and therapeutic bed-holds that exceed 18 days during a 12 month period no longer require DOH prior approval numbers.
To reflect these changes in your CHARTS Software you will need to do the following:
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1. Change ALL of your Medicaid Billing Code Table files as follows: --------------------------------------------------------------------------------------
a. From any CHARTS menu type CTF [or GM, 15, 2] and press ENTER.
b. At Table type 8 for Accounts Receivable and press ENTER.
c. At Enter Table Number type 3 and press ENTER.
d. At Enter Main Key type 11 and press ENTER.
e. At No. Bedhold days allowed type 20 20 and press ENTER.
f. Repeat steps d. and e. for each Medicaid bill type you use.
g. Press PF 12 or PF 16 to exit the Table File program.
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2. Change your User Parameters as follows
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a. From any CHARTS menu type NHMA and press ENTER.
b. At Bed Hold Release: type Y and press ENTER.
Thank you.
Sincerely,
Reliable Health Systems, Inc.
See related article in NYAHSA Advisor, 7/22/96: Bed Hold Prior Approval Requirements Rescinded The Department of Social Services (DSS) recently notified NYAHSA and providers that the department has retracted certain prior approval requirements for bed reservations covered by Medicaid, effective June 1, 1996. Longstanding DSS policy had required nursing facilities to request prior approvals from area offices of the Department of Health (DOH) for Medicaid bed reservations between the 15th and 20th day of an inpatient hospitalization, as well as for therapeutic leaves in excess of 18 days during a 12-month period. Effective June 1, nursing facilities will no longer be required to submit a status of bed reservation form (DSS-3074) to the DOH area office to seek prior approval in these instances. However, current Medicaid policies that establish a 20-day limit per hospital stay on bed reservation payments, as well as other general requirements (e.g., facility vacancy rate no more than five percent, prior 30-day residency in facility, etc.), continue to apply. While the DSS-3074 form and DOH prior approvals are no longer required, nursing facilities are expected to retain signed physician justifications on file for audit purposes, as well as to keep relevant records. Existing Medicaid billing instructions for reserved bed days continue to apply, except that the prior approval number (field 28) should be left blank. The payment edit for prior approvals in the Medicaid management information system (MMIS) was deactivated on June 1. Providers with questions about this change should contact Loretta Grose, DSS, at 518-474-9151, or DOH's Bureau of MMIS at 800-342-3005.