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Successfully billed Room and Board enhanced rates

Jenna 1 year ago in Billing/Electronic Modules updated 10 months ago 11

We were finally able to successfully bill the enhanced rates on our room and board line. It has always been on the grid rate sheet but we never were able to get it through. We billed enhanced rate with with child (U6) and medical (U5). After a few phone calls with DHS and asking the right questions we were able to bill directly on the MN-its website and get paid. 

Now when setting up our current clients with the room and board plus modifiers in Procentive it cannot clear their system. They say that DHS has been made aware of the issue that when sending in batch form it will not clear a revenue code with modifiers. Only a CPT code with modifiers. 

They also said that most people (like us before) just end up getting paid the base rate. So to test it out first. If entered right on MNit's you can get paid for this. It is a substantial amount of money over the course of a year billing out these rates. 

We are wondering who else is having this issue and if enough of us raise and issue with Procentive /DHS  the proper changes can be made so we can bill out of Procentive without having to go into MN'its directly to edit and bill the Room and Board w/ mods for every client in the facility. 

Answer

+1
Answer

Hello all, 

Procentive has been in contact DHS regarding the modifiers for Residential Codes. DHS is currently rejecting the modifiers on the claims, as including a modifier on these codes is not in alignment with 5010 billing guidelines. In speaking with them, they have acknowledge this and have told us they are working on it from their end.

Thank you to those that have shared their experiences and insights on how to get these claims acknowledged by DHS.
If you have further questions on this topic, or need further research into these types of claims, please contact DHS.


If anyone has questions on adding additional codes, associating codes with payers or adjusting rates for payer, please submit a Help Desk ticket.

Thank you,

Amanda Kaufmann

Customer Success Manager

So to bill the enhanced R&B rates, you don't use the modifiers.  You'll want to add the enhanced amounts onto the base rate, and change your rate in Procentive.  Also, in the payer set up, payer rules tab, make sure you have "Add value code 24 to room and board claims" set to YES.

Hello! We have also run into this issue. Our non-profit was established in December of 2015. We have been approved to bill the updated room and board rates (U5) plus the CD services we provide at high, medium, and low intensity since the time we opened. When I spoke with Procentive in the fall of 2018, I was told that Procentive had not yet found a way to successfully bill these updated codes through Procentive so that the codes could be read in the state's system. To my understanding, it is a concern that Procentive has been working on for quite some time. Because we are a small non-profit, this affects us greatly, and we would like to get to the bottom of it. 

We have a corporate attorney looking into this issue at this time. If anyone has any concerns or information about codes being billed, approved or rejected, please email shellyp.compassionhouse@gmail.com. At this time, we are trying to raise awareness to the scale of this issue in Minnesota. Any information you have is greatly appreciated!

We were dealing with this issue for a long time but found a workaround, at least for the U6 modifier. I am not sure if it would work for U5. 

We created a copy of the plain 1002 for room and board with children and didn't add the modifier. However, we changed the bill rate in the payers module to match what it would be with the modifier. Then we titled it "room and board with children" to delineate it from the original code. We have successfully billed and recaptured the correct rate this way for multiple months now. Might be worth a shot for everyone.

Thanks,

Chris

Hey Chris! 

Do you have to go in and edit in MNits to add the modifier after? We were just talking about sending out at the enhanced rate with just 1002 so that way when we go in and edit - the payment coming in matches the invoice! Thanks for the idea to save it labeled and rated differently! 

I wasn't even able to get room & board to pay when entering them on MN-ITS with the modifiers.  Again, you have to add the enhanced amounts to the base rate.  Procentive AND DHS won't take a rev code with a modifier.  I have been successfully billing & collecting enhanced room & board rates by adding the enhanced rates to the base rate & billing with no modifier.  There is actually an old DHS bulletin that states this is how it should be billed.

Heather, do you have a copy of the DHS bulletin? Thanks!

Jenna,

What I have noticed is that the modifier gets picked up in MN-ITS automatically when it is billed out, at least for U6. For example, we bill a claim at 1002 "Room and Board with Children" with no modifier but a rate of $69.10. When it comes back through on the remittance through Procentive it doesn't show the modifier but it pays at the right rate, and matches on the claim when we click Save All for payment entry.

When I look up the claims in MN-ITS, the modifier is there, so I am guessing it gets added automatically due to the service agreement having the room & board with a modifier. We are also the funding authority for a portion of our clients and in MMIS we do see the units coming off the service agreement accurately, so it does not create an issue there, either.

It's unorthodox, but it works, and it's definitely a solution until something changes with the billing process either with Procentive or MN-ITS. 

It worked!! Thanks so much! 

Great - I am glad it worked for you as well! Talk about a time saver.

+1
Answer

Hello all, 

Procentive has been in contact DHS regarding the modifiers for Residential Codes. DHS is currently rejecting the modifiers on the claims, as including a modifier on these codes is not in alignment with 5010 billing guidelines. In speaking with them, they have acknowledge this and have told us they are working on it from their end.

Thank you to those that have shared their experiences and insights on how to get these claims acknowledged by DHS.
If you have further questions on this topic, or need further research into these types of claims, please contact DHS.


If anyone has questions on adding additional codes, associating codes with payers or adjusting rates for payer, please submit a Help Desk ticket.

Thank you,

Amanda Kaufmann

Customer Success Manager

Hello! I am curious if anyone has been able to get an answer from the state as to what value codes we can used with 1002. The new value code sheet for room and board does not have the option for what we need...

1002 w/ child w/ medical 

or 

1002 w/ medical 

So we cannot bill.  I know procentive is working to get value codes added in - but even then we don't have a value code for those enhanced rates to edit/ bill out of MN -its.

Any ideas?!