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The system update to automate payments of Long Term Acute Care Hospitals, Rehabilitation Hospitals, and Spine/Brain Injury Treatment Specialty Hospital was completed February 27, 2020, but had an issue related to crossover claims.
Claims will continue to suspend under edit 7500 until the error impacting Medicare Crossover claims are resolved. The Department will keep the Providers apprised of when the suspension edit is removed and full automation of claims begins. Claims, where Medicare is the primary payer, should continue to be billed in the interim. Additionally, the billing guidance to rebill claims which span the implementation date is almost complete and will be released to Providers shortly.
February 19, 2020
The interim solution has been tested successfully. All remaining Providers have been moved to the interim solution. Claims with dates of service July 1, 2019 and beyond will show in a suspended status for a short time until the claims are manually priced to the per diem methodology.
The reprocessing of claims paid under APR-DRG reimbursement methodology will be communicated directly to Providers. Andrew Abalos will reach out to the Provider with a list of ICNs, Dates of Service and estimated impact. We anticipate beginning the reprocessing on January 2, 2020.
An interim solution has been developed to price claims with admit dates of July 1, 2019, and beyond, using the per diem methodology until a permanent solution is implemented in 2020. The solution is currently being tested with the assistance of two (2) providers. Once implemented, claims will show in a suspended status for a short time until the claims are priced manually.
Contact Andrew Abalos at firstname.lastname@example.org with additional questions.
We appreciate everyone’s patience while we await system updates to be completed. Currently, all Long Term Acute Care (LTACs) and Rehabilitation hospitals enrolled with Healthfirst Colorado will receive interim payments under the old APR-DRG reimbursement methodology. When the system updates have been completed, we will announce a meeting via email and web posting to discuss the requirements for split-billing claims that span the implementation date of July 1, 2019, and mass adjustment schedule of all claims with admit/discharge date on/after July 1, 2019.
We have almost completed the update process and will have a date of system implementation by the end of October. Once we have received a date we will post to the Inpatient Per Diem Webpage and email everyone on our Per Diem provider list. The system update will have to be retroactively effective to July 1, 2019.
The interChange system has not been updated to accommodate the new Per Diem rates or split-bill capability of claims that cross over the implementation date of July 1, 2019. During the June 25, 2019, Per Diem Provider Meeting, the Department instructed Providers to continue to bill as normal until written instructions from the Department are communicated on how to complete the split-bill of claims that crossover the July 1, 2019 implementation date. Contact Andrew Abalos at email@example.com for any questions or concerns.
After careful review of the feedback received from the last Per Diem Engagement Meeting held May 7, 2019, the Department has decided that the Long Term Acute Care Hospitals, Rehabilitation, Hospitals, and Spine/Brain Injury Treatment Hospitals will need to split bill any hospital stays that cross over the implementation date. This means that any client admitted prior to July 1, 2019, and discharged after June 30, 2019, would have two different claims. One claim will have a discharge date of June 30, 2019, and will use the APR-DRG methodology to calculate the claim payment. The second claim will have an admission date of July 1, 2019, and utilize the new per diem methodology to calculate the payment for the remainder of the stay. Contact Andrew Abalos at firstname.lastname@example.org for any questions or concerns.
Conference Line: 1-877-820-7831 Passcode 294442#
Presentation Meeting Summary
2/25/2020 Webinar Recording
The next Inpatient Hospital Per Diem Reimbursement Meeting is set for Tuesday, June 25, 2019, 2.00pm - 3.00pm
6/25/2019 Webinar Recording
Presentation Meeting Summary
5/7/2019 Webinar Recording
For questions regarding rates and their calculations please contact Andrew Abalos at email@example.com
Related Links: Links to Inpatient Hospital Rates Page , Outpatient Hospital Rates Page and Hospital Stakeholder Engagement Page