Harmony Healthcare Blog

Medicare Advantage Organization HIPPS Codes Update

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Jul 07, 2014

Clarification is in order. Originally, when billing for all Medicare Advantage Organizations (MAO), PACE Organizations, Cost Plans, and certain demonstration projects, providers were originally told by CMS that they must provide Health Insurance Prospective Payment System (HIPPS) Codes for Skilled Nursing Facility (SNF) claims submitted effective July 1, 2014. This left Skilled Nursing Facility providers concerned that they would then be required to follow the traditional Medicare PPS schedule in order to accurately provide HIPPS codes for billing.  On May 23, 2014, CMS released a memo regarding Submission of Health Insurance Prospective Payment System (HIPPS) Codes to the Encounter Data System to all MAO providers clarifying the requirements.

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Topics: CMS, Managed Care, MDS Coding

Avoid Lost Revenue by Understanding Your Managed Care Contracts

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Apr 30, 2014

Managed Care Organizations are quickly becoming substantial components of the skilled nursing reimbursement system.  We are noticing a trend in facilities where key players have limited or no access to the specifics of different Managed Care contracts that were negotiated for the facility. 

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Topics: Documentation, Reimbursement, Managed Care

New York State Transitions to Medicaid Managed Care Plan March 1st

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Mar 04, 2014

Effective March 1, 2014, all eligible beneficiaries over the age of 21 in New York City, Nassau, Suffolk and Westchester counties, in need of long term placement in a nursing facility, will be required to join a Medicaid Managed Care Plan (MMCP) or a Managed Long Term Care Plan (MLTCP).  The rest of New York State is scheduled to begin transitioning this coming September for both dual and non-dual eligible populations and all upstate counties will be phased in by December 2014.

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Topics: Medicaid, Medicaid Reimbursement, Managed Care

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