Medicaid Provider Reminder
The Agency for Health Care Administration (the Agency) reminds all providers receiving reimbursement through the Medicaid fee-for-service delivery system that they must comply with all requirements in general and service-specific Florida Medicaid handbooks and policies.
Providers must report address changes and any change in their managing employees in accordance with their Medicaid Provider Agreement and the Florida Medicaid Provider General Handbook to ensure accurate communication and prompt payment for services rendered.
If you have changed your address or telephone number and have not updated your information with the Agency, this is a good opportunity to do so. The Provider General Handbook (page 2-49) requires the following:
“Providers must promptly notify Medicaid of any change of address by calling the Medicaid fiscal agent’s Provider Services Contact Center at 1-800-289-7799 and selecting Option 4. The following four addresses may be housed on the provider file: service address, pay-to-address, mail-to or correspondence address, and home or corporate office address.”
If closing out a former managing employee, list the individual’s name and the date they departed. If adding a new managing employee, list the individual’s name, home address, date of birth, social security number, whether they are the financial or medical custodian, and the date they started. Background screening is required. Please view the Background Screening page under Enrollment on the Medicaid Public Web Portal for more information.
Florida Medicaid coverage policies are located on the Agency’s Florida Medicaid Web Portal.
To receive notifications on specific Florida Administrative Code (FAC) Agency rules, visit the FAC Web site and select “Subscribe for Notifications.” Updates on Florida Medicaid rules are also posted to the Agency’s Rules Web site.
Payment Error Rate Measurement (PERM) Webinar Training for Medicaid and CHIP Providers
Tuesday, May 9, 2017, 10:00 – 11:00 am
Thursday, May 11, 2017, 2:00 – 3:00 pm
The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and CHIP and produces error rates for each program. The Centers for Medicare and Medicaid Services developed this program to comply with the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act or IPERA) and related guidance issued by the Office of Management and Budget.
The PERM error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and Children’s Health Insurance Program (CHIP) in the federal fiscal year (FFY) under review. It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements. FFY 2008 was the first year in which CMS reported error rates for each component of the PERM program.
The webinar training will provide an overview the PERM program. Focus topics will include sharing Florida’s Medicaid medical record review findings from FFY 2014 and preparing Florida Medicaid and CHIP Providers for the upcoming medical records requests during FFY 2017. Please click the below link to register for one of the training dates.
May 9th https://attendee.gotowebinar.com/register/4672952287791747329
Medicaid Compliance Awareness
Providers are encouraged to develop a compliance-training program, to seek educational opportunities, and to educate staff on the statutes, rules, contracts, and federal and state regulations that govern the Florida Medicaid program.
The Medicaid Provider Agreement states that a provider agrees to comply with all local, state, and federal laws, as well as rules, regulations, and statements of policy applicable to the Medicaid program.
Sources of Florida Medicaid policies include, but are not limited to, provisions of Chapter 409, Florida Statutes, Rule 59G, Florida Administrative Code, and Medicaid Handbooks.
The Office of Medicaid Program Integrity conducts reviews for provider non-compliance and oversees the activities of providers to ensure that fraudulent, abusive behavior and neglect of recipients occur to the minimum extent possible. Florida Statutes and rules allow the Agency to pursue overpayments; to impose sanctions such as fines, suspensions, terminations; and to assess costs pertaining to investigative, legal, and expert witness expenses. For example, goods or services when provided must be medically necessary and must be properly documented when rendered. In regard to record retention, Section 409.913(9), Florida Statutes, states, “A Medicaid provider shall retain medical, professional, financial, and business records pertaining to services and goods furnished to a Medicaid recipient and billed to Medicaid for a period of five years after the date of furnishing such services or goods.” Failure of a provider to meet medically necessary requirements, failure to maintain required documentation, or failure to furnish documentation to the Agency are some examples of Medicaid policy violations that can result in overpayments due back to the Agency by the provider, as well as sanctions being imposed and costs assessed for recovery of expenses.
You are encouraged to enhance your knowledge of Medicaid policy to avoid billing errors and non-compliance issues.
Requirements to Notify the Department of Children and Families (DCF) of Nursing Facility Admissions and Discharges
The Florida Department of Children and Families (DCF) must be notified of a Medicaid recipient’s admission to a nursing facility or discharge from a nursing facility, including those recipients enrolled in the Statewide Medicaid Managed Care (SMMC) Long-term Care (LTC) program and in the SMMC Managed Medical Assistance (MMA) program. Upon notification of a nursing facility admission or discharge, DCF updates the recipient’s demographic information in the DCF computer system and makes any necessary changes in the recipient’s Medicaid eligibility aid category and patient responsibility.
Within 10 working days of the Medicaid recipient’s admission to a nursing facility, DCF must receive a completed DCF #2506A Form (Client Referral/Change). When the recipient is not enrolled in the LTC program, the nursing facility must submit the DCF #2506A Form to DCF. When the recipient is enrolled in the LTC program, the case manager with the LTC plan must submit the DCF #2506A Form to DCF. If a LTC plan delegates submission of the DCF #2506A Form to the nursing facility, the LTC plan must obtain a copy of the form submitted to DCF and retain a copy of that form in the plan member’s (enrollee’s) file.
Within 10 working days of the Medicaid recipient’s discharge from a nursing facility, DCF must receive a completed DCF #2506 Form (Client Discharge/Change Notice) from the nursing facility when the recipient is not enrolled in the LTC program and a completed DCF #2515 Form (Certification of Enrollment Status, Home and Community Based Services (HCBS)) from the LTC plan when the recipient is enrolled in the LTC program. LTC plans may not delegate submission of the DCF #2515 Form to the nursing facility.
The DCF #2506 Form, DCF #2506A Form, the DCF #2515 Form, and the instructions for the DCF #2506A and #2515 are accessible the Medicaid Nursing Facility Provider Information website.