by mbpoweski
22. July 2009 19:12
Bundling Update
Effective Date
We are getting more indications that ODJFS does not intend to enforce a July 1, 2009, effective date on bundling. No official announcement has been made, but signs are pointing that direction. For instance, a draft administrative rule on wheelchairs states that custom wheelchairs that are “in process” on the effective date of the rule (which is not finalized yet) will be paid through the direct billing mechanism. We hope to have an answer on effective date in the next couple of days.
Coinsurance
Although ODJFS has told us verbally on several occasions that Part B coinsurance for therapy is included in bundling (and the cost of coinsurance was factored into the $3.91 consolidated services payment), we are pushing the department not to include coinsurance. It should be noted that coinsurance for other bundled items that are covered by Part B is not bundled.
Another note on Part B therapy – there is nothing about bundling that prohibits billing Medicare Part B. The issue is about billing the coinsurance to Medicaid, if the patient does not have other insurance that covers it.
Fee Screens
When ODJFS established the $3.91 per diem for bundled services, that amount represented the sum of calculated per diems for the five services. The per diems were determined based on the amounts Medicaid paid for the services under direct billing. As a result, the fee screens Medicaid uses for payment purposes are relevant for SNFs in determining how much to pay for the services going forward. The fee screens for transportation, oxygen, and wheelchairs are available at OHCA Online under Ancillary Bundling on the Reimbursement page (www.ohca.org/content/view/93/243/).
ODJFS, however, did not totally base the per diems on the fee screens. In the case of oxygen, the per diem was based on $50 per month for concentrator rental, considerably below the current fee screen. Also in the case of over-the-counter drugs (for which we have not yet received the fee screen), there was a downward adjustment. We do not believe there were adjustments for wheelchairs, transportation, or therapy, but we are awaiting confirmation of that.
Should you have questions, please contact Pete Van Runkle (pvanrunkle@ohca.org), 614/436-4154 or Mike Compton (mcompton@ohca.org), 614/540-1326.
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