[Provider] Billing Update for Residential Care Facilities

[Provider Notification]

ATTENTION:  All MaineCare Providers Previously Billing "Bed Hold" Days

 

 

Effective 8/1/08, new rules went into effect that discontinue MaineCare
payments for so-called "bed hold" days.  This is being done in
conjunction with a budget initiative and in order to comply with federal
requirements.  

 

In order to help defray the fixed costs associated with temporary
absences, and to ensure that facilities continue to have the capacity to
hold beds for residents during short term absences, the Department is
increasing MaineCare rates for residential care providers by $1.52 per
day.  In addition, the Department will continue to pay the routine
component (which is paid with state funds) for bed hold periods of up to
30 days.  

 

Providers should continue to use procedure codes BQ, BP, RMR or MRP to
bill for Medical and Remedial Services and for Personal Care Services.
Billing is only allowed for days that a member receives covered services
from the facility.  Billing should continue for the routine component
using procedure code BH or MRB for the days that a member is in the
facility and BHL or MRBL for bed hold days of up to 30 days when a
member is on a leave from the facility. 

 

In the aggregate, the net savings from these changes are equivalent to
the amount spent last year for bed holds in excess of 30 days, based on
paid claims data.

 

We recognize that these changes will require providers to change the way
they manage bed holds, especially longer term absences.  In addition, we
recognize that meeting the needs of residents who must leave a
residential facility for higher levels of care will require flexibility
on the part of providers.  For example, policy changes to give priority
in the admission process to residents returning from longer term
absences should be adopted in order to provide continuity for those
residents.

 

We look forward to working with providers to implement these changes in
a manner that will minimize disruptions for residents of residential
care facilities.  

 

Please contact the MaineCare provider relations office at
1-800-321-5557, Option 9 for further assistance.

 

 

This is a one-way communication.  Please do not respond to this message.

 




 

 

 

 

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