NARHC Forum
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| 7/27/2021 @ 2:59:00 PM
Post 1 of 6
Contributor: Tina Lyden, Lawrence County Health Department RHC
We are an independent RHC located in Illinois. Our state is currently expanding their Medicare-Medicaid Alignment Initiative (MMAI) program statewide. I have been a little concerned about the wording in some of the contracts that I have seen. I had asked if our RHC would still receive our AIR for both Medicare and Medicaid. This was the response from one of the plans: For the dually eligible population (MMAI - Medicaid and Medicare) reimburses according to Medicare as reflected in Exhibit A of the agreement: All covered out-patient services shall be reimbursed at a payment rate of one hundred percent (100%)‪ of the Medicare allowable in effect on the date of service for the locality in which the Provider is located, not including Medicare coinsurance or deductibles, as primary coverage. Due to this, Medicaid should not be billed for this dual population only Medicare. Does anyone have any experience with MMAI in a RHC? Do you get paid your AIR? Also, if we can’t bill MCD for MCR coinsurance or deductibles are we allowed to bill the patient? I tried looking up a few of our CPT codes on the MCR fee schedule and looked to me like we were going to be taking quite a reduction with our payments. Any advice or suggestions would be greatly appreciated!! Tina Lyden, RH-CBS
7/27/2021 @ 3:08:00 PM
Post 2 of 6
Contributor: Cassie Beesley, Springfield Clinic - Hillsboro East
We have found this very difficult with these new contracts and are having numerous conversations with each of them. They do not understand how the RHC billing works in regards to these dual-eligible patients. The part that concerns me with all of this is that we are losing out the Indigent Medicare Bad Debt for the dual eligible patients as they are transitioning all these patients to an MMAI plan. We have been working with the plans one on one to negotiate payment in line with current total reimbursement we are eligible for with the dual eligible patients. Getting paid 100% of the Medicare rate only is a loss for us over what we are currently receiving, because the inability to capture the 65% of the bad debt on the portion they are not covering. It is a mess.
[cid:image003.png@01D4EA20.04F19020] Cassie Beesley, CRHCP Rural Health Clinic Manager Springfield Clinic Phone 217.528.7541 x44801 This electronic message contains information from Springfield Clinic, LLP that may be confidential, privileged, and/or sensitive. This information is intended for the use of the individual(s) or entity(ies) named above. If you are not the intended recipient, be aware that disclosure, copying, distribution, or action taken on the contents of this information is strictly prohibited. If you have received this electronic message in error, please notify the sender immediately, by electronic mail, so that arrangements may be made for the retrieval of this electronic message. Thank you. 7/27/2021 @ 4:35:00 PM
Post 3 of 6
Contributor: Jackie King, ArchProCoding
Please email me at jking@icahn.org
Thank you, Jackie [cid:image001.png@01D782FC.AF202D50] Register today for the 2021 ICAHN Expo on August 27 in Springfield! Jackie King, MSHI, CPC, COC, CRHCP Director of Compliance & Clinical Informatics, HIM Consultant Phone: 815.875.2999 Mobile: 815.973.9649 Email: jking@icahn.org 1945 Van's Way Princeton, IL 61356 www.icahn.org [A picture containing text, first-aid kit, clipart, vector graphics Description automatically generated] 7/27/2021 @ 4:39:00 PM
Post 4 of 6
Contributor: alison.davis@carle.com
I would appreciate this info as well. My health system also has RHC's in IL.
Alison Davis, CPC, CEMC Manager, Business Office Operations/Revenue Integrity Carle Patient Financial Services (217) 902-5905 Desk [cid:image007.png@01D6F552.41E728C0] Sensitive Information Encrypt Requested 7/28/2021 @ 12:45:00 PM
Post 5 of 6
Contributor: Charles James, North American Healthcare Management Services
Yes - I can certainly help out on this. I will send you a message.
Charles A. James, Jr. President and CEO North American Healthcare Management Services 1921 South 9th Street • St. Louis, Missouri • 63104 314.968.0076 x201 Office 314.560.0098 Cell www.northamericanhms.com 'Proper preparation prevents poor performance." Lt. Col. Tom Warner - paraphrased (USAF- Deceased) [cid:image001.jpg@01D783A5.AC536CF0] This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 9/20/2021 @ 12:39:00 PM
Post 6 of 6
Contributor: emily.gaddis@sih.net
I am also interested in any MMAI information you can pass along. My organization has several RHC's in southern Illinois, as well as, four hospitals. Thank you. |
