Semi-Annual Third Party Liability Repayment Letters
The New York State Office of the Medicaid Inspector General (OMIG) has sent a letter to selected home health providers to resume the semi-annual demand billing process for the Federal Fiscal Year (FFY) 2016 Medicare Maximization Services Initiative. This process is to ensure 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).
OMIG has contracted with the University of Massachusetts Medical School (UMass) to perform the Medicare Home Health Appeals Initiative. The Aug. 5th letter sent by OMIG informs 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 time period of the first half of FFY 2016 only. Dates of service for this report include Oct. 1, 2015 to March 31, 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