RI Nursing Facilities - Medicaid Advance Recoupments to Commence in May

The recent news cycle continues to focus attention on the State of Rhode Island’s cash outflows related to Medicaid advances. Last week, the State announced its plan to automatically and systematically recoup from the monthly remittance advances for which Medicaid eligibility has been approved.  The recoupment will take place over a 14-month period beginning in May 2019.

Do you have the necessary information readily available to reconcile and verify the recoupment amounts?

To facilitate, anticipate and verify the accuracy of the monthly recoupments, assemble the documentation that provides detailed information about advances, eligibility approvals, and related claims that have been settled through MMIS. The following information, located in one place and reconciled to your internal records, will facilitate this reconciliation.  

• A list of patients for whom an advance was requested showing
  • Medicaid application date
  • Application approval date
  • Related dates of service
• Details about the advance
  • Date of request
  • Date received
  • Amount received
  • Dates of service
• Details about eligibility approvals
  • Date of approval
  • Related approved dates of service
• Details about the related settled claim
  • Date received
  • Amount received
  • Dates of service
• Identification of differences
  • Amount
  • Description
    
    • Differences in dates of service
    • Applied income considerations
    • Other

Note: Providers remain eligible to request additional advances. 

Throughout this process, it is important to keep your stakeholders, (staff, patient’s families/responsible parties, service providers, referral sources, decision-makers, influencers), informed about your proactive efforts and results.