Provider Notice issued 11/28/05

To: Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers

Date: November 28, 2005

Re: Inclusion of Medicare HMO Services for Disproportionate Share Calculation

The department has initiated a new billing policy related to patients who are covered under both Medicaid and a Medicare HMO. This new billing policy will allow hospitals to identify the inpatient days of Medicaid patients who receive Medicare HMO coverage in lieu of standard Medicare coverage.

The department will pay these claims at zero, but the inpatient days will be included in the hospital’s disproportionate share calculation. This change is effective retroactive to the beginning of each hospital’s fiscal year 2004. Therefore,  hospitals are encouraged to bill all applicable inpatient services for these days to be considered in the disproportionate share determination for rate year 2007.

For patients who have Medicaid coverage in addition to Medicare HMO coverage, hospitals should submit an institutional Medicare/Medicaid crossover claim to the department with the following required additional information:

• Condition Code: Condition Code “4” (Information Only Bill) must be present
  
• Value Code and Amount: The claim must contain an applicable value code for the deductible due according to your Medicare payer line. For example, if the Medicare Payer line is A, Value Code “A1” must be used with an associated amount of “0.00”

Aside from the additional information above, claim preparation and submittal for these claims is the same as for other Medicare/Medicaid crossover claims; i.e., the payer name must be listed as “Medicare,” and the TPL code for Medicare and the Medicare HMO payment amount must be present.

As you may know, the name of the Department of Public Aid (DPA) has changed to Healthcare and Family Services (HFS). We are in the process of updating forms, handbooks, and the Internet with our new name. However, until existing supplies are exhausted, we will continue to use materials bearing the former DPA name and logo. Either version of documents should be considered official regardless of the department name they bear.

Only our name has changed. HFS’s programs, staff, office locations, mailing addresses and phone numbers remain the same as DPA’s. We believe our new name more clearly reflects our mission of service to the State of Illinois including providing access to health care for over two million Illinoisans. In our work, we deeply appreciate your participation in our programs .

Providers wishing to receive e-mail notification, when new provider information is posted by the department, may register at the following HFS Web site at:

                                        http://www.hfs.illinois.gov/provrel

If you have questions regarding this notice, please contact the Bureau of Comprehensive Health Services at 1-877-782-5565.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs