Agencies
Services
Provider Notice Issued 05/28/2021
Date: May 28. 2021
To: Enrolled Hospice Agencies
Re: Hospice Nursing Home Room and Board N39 Rejections
This notice is a reminder to hospice agencies to bill the appropriate HealthChoiceIllinois managed care plan for managed care hospice patients’ nursing home roomand board charges. This includes room and board charges for customers enrolledin the Managed Long Term Services and Supports (MLTSS) program.
Per informational notice dated September 20, 2018 and the IAMHPBilling Guide, hospice agencies areto bill the appropriate managed care plan for both the hospice services andalso nursing home room and board charges, if the patient is in managed care andresides in a nursing facility. Some hospices have billed the Departmentdirectly for nursing home room and board charges, and due to a system editingissue, those claims were erroneously paid. The editing issue was fixed as ofMarch 30, 2021, and claims are now rejecting appropriately for the N39 - Recipientin MCO-MMCP error code, if room and board charges for a managed care customer arebilled to the Department.
The Department and the managed care plans will internally reconcile theinappropriate room and board payments made. No action is required by thehospice agencies.
Questions regarding this notice may be directed to the applicable HealthChoice Illinois managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs