OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals
The NYS Office of the Medicaid Inspector General (OMIG) has resumed its semiannual demand billing process for claims for the second half of Federal Fiscal Year (FFY) 2016 only. This is to ensure regulatory compliance for dual eligible Medicaid/Medicare beneficiaries. OMIG has contracted with the University of Massachusetts Medical School (UMass) to perform the Medicare Home Health Appeals Initiative. As we have previously reported, this process is to ensure that providers seek reimbursement from Medicare and all other third parties before submitting a claim to Medicaid (Section 540.6(e) (1) of Title 18 NYCRR).
The March 6th letter sent by OMIG notifies agencies which dual eligible Medicare/Medicaid beneficiaries they are required to submit to Medicare for a coverage determination. OMIG is requesting that agencies demand bill each beneficiary for the period listed on the enclosed FFY 2016 - Semiannual Case Selection Report. Dates of service for this report include April 1, 2016 to Sept. 30, 2016 and include both fee-for-service and Episodic Payment System (EPS) claims. If your agency is selected for future initiatives, you will receive a separate notification letter and Case Selection Report at that time.
For specific questions about the Medicare Home Health Appeals Initiative, contact Laurie Burns of UMass at 866-626-7594.
If you want to know if your agency is listed on the FFY 2016 - Semiannual Case Selection Report, please contact me.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871