DOH Guidance on Hurricane Irene Billing

TO: Facilities Impacted by Recent Weather Emergencies

FROM: Patrick Cucinelli, Senior Director of Public Policy Solutions

DATE: February 23, 2012

SUBJECT: DOH Guidance on Hurricane Irene Billing ROUTE TO: Administrator, CFO, Billing

ABSTRACT:  DOH offers direction on Hurricane Irene billing with March 8 claims submission deadline.

Introduction
The Department of Health (DOH) has issued the following email and attached instructions to nursing homes and hospitals that either transferred or received residents during Tropical Storm (originally Hurricane) Irene, which impacted primarily Downstate areas around August 28, 2011.  Please note that these instructions do not apply to facilities later impacted by Tropical Storm Lee, which created massive flooding and some permanent facility closures in Upstate areas around September 5, 2011. 

Submitting Claims (Irene)
The deadline for submitting claims for transferring facilities only under the Tropical Storm Irene guidelines and using the “DR” modifier is March 8, 2012.  This includes the re-submission of claims previously submitted without the required modifier.  LeadingAge NY is providing impacted members with this information in the event that you may have missed the original e-mail from DOH.  Also, for member convenience, the Q&A document referenced in the email message is attached. 

• For Receiving Facilities (Irene)

LeadingAge NY obtained the following additional clarification from DOH on the process for receiving facilities only for Tropical Storm Irene:

“ … the receiving nursing homes cannot bill yet; we [DOH] wanted all claims in from evacuating homes and hospitals. The reconciliation will take place after the March 8th date when we pull all the claims from the evacuated facilities. We will then have to reconcile between the evacuators who have been paid and the receivers who need to be paid. We will be contacting facilities on what information we will need for this process. The receiving hospitals and nursing homes will be taken from the list of providers who submitted surveys last September.”

 

A Note on Lee
Based on discussions with DOH, specific guidance on billing issues related to Tropical Storm Lee are due to be released soon.  They are viewing the two weather events as separate with distinct concerns, based mainly on the fact that the Upstate flooding resulted in the permanent closure of facilities and transfer of residents.  In general, residents transferred from a closed facility should be treated as permanent new admissions to the receiving facility and already billed accordingly.   Regarding any short term transfers, DOH anticipates that their Lee billing guidance will likely mirror this current guidance for Irene, but this has yet to be finalized.

Most Recent DOH Message

Dear Administrators/Controllers,

The Department continues to work with both eMedNY and CSC to implement a process to
reconcile payments for those facilities who either transferred or received patients during the
Tropical Storm Irene emergency evacuations.

To date, the receiving facilities have not yet been able to bill. The Department is working on
a method by which the receiving nursing homes will be reimbursed for the Medicaid patients
they received from evacuating facilities. At the same time, those facilities who had patients
evacuated will also be reconciled.

In order to expedite the reconciliation process, the Department reminds all affected facilities
that all Medicaid fee-for service submitted claims related to this emergency (with the
exception of providers using the eMedNY ePACES system), whether transferred out or
received between health care providers or other service providers, must include "DR"
(Disaster Related) in the condition code field of the claim. This will provide OHIP with the
ability to track these claims to determine appropriate payments made related to this
emergency. If claims were submitted already, it is critical to the process that these claims
be resubmitted with the "DR" on the claim. Please see the October 23, 2011 email
attachment titled "Questions and Answers regarding Tropical Storm Irene - Billing (see below).
Providers using the eMedNY ePACES system have not been able to have their claims processed
with the DR code. These claims should be resubmitted as soon as possible without that code on
them.

All claims pertaining to the Tropical Storm Irene period should be filed no later than
March 8, 2012. Subsequent to that date, we will begin the reconciliation process by
pulling the claims associated with the emergency time period. Once the reports are generated
from the eMedNY system, providers will be requested to submit additional information to
complete the reconciliation process.

Please contact us via email at bpacr@health.state.ny.us if you have any questions. Additional
communication will be forthcoming from the Department as this process moves forward.

Thank you very much.

John W. Gahan Jr.
Director
Bureau of Primary & Acute Care Reimbursement
Room 1043
NYS Department of Health
518-474-3267

Conclusion
Again, please see attached for the document referenced in the DOH message.  LeadingAge NY has continued to advocate on a resolution to this issue for impacted members and we are interested in any ongoing concerns members may have.  Please contact me with any concerns or questions at pcucinelli@leadingageny.org or call 518-867-8827.

Attachment

N:\NYAHSA\Policy\pcucinelli\Hurricane Irene\February 2012 Hurricane Irene.doc