Charting patient histories for Medicaid reimbursement is a complex and essential task for Skilled Nursing Facilities (SNFs). To determine the proper amount of payment, treatments and procedures are categorized according to level of care, and multiple factors must be coordinated according to specific guidelines. Medicaid will also work with primary and other co-payers as needed, based on the information charted by the SNF.
Level of Care
Medicaid requires the skilled nursing facility (SNF) to chart the level of care that a patient is receiving, whether for an observation period, medical care or hospice care. Medicaid reviews each of the charted level of care and the treatments that the patient received to determine if the correct level of care was documented. If not documented correctly, Medicaid could deny the claim or return it to the SNF for correct filing.
Payer
The primary payer must be reported to Medicaid, as Medicaid is not always the first payer on the account. However, if Medicaid determines that the primary payer hasn't covered its share of the bill or treatments that it should be responsible for, it reserves the right to contact the primary payer. The SNF must submit this information on the charting paperwork.
Co-Pay
Patients who are covered by Medicaid but have been admitted to an SNF with a financial co-payer as in a worker's compensation claim in which the employer is responsible for paying a significant portion of the bill must report this to the SNF. In such situations, Medicaid can contact the co-payer to determine who is liable for the payment of specific charges as needed. If the SNF fails to chart this information correctly, it could face a delay in payment from both the co-payer and Medicaid.
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