Home Care Updates
Find important information affecting provider payments here.
For Newly Enrolled Recipients
- Beginning January 1, 2014 The Illinois Department of Healthcare and Family Services is making monthly nursing service allocations for newly enrolled recipients. This represents the maximum monthly resource allocation approved for a recipient – the level takes into consideration school hours and private insurance as well as services supported by IDHFS.
- The 2352 for those children reflects a monthly maximum.
- Weekly billings remains in effect, however monthly resource allocation claims must be split at the end of the calendar month.
- This Excel template (need file to upload to server) can be used to monitor a recipient’s monthly services.
- As you know, the General Assembly rolled back rates 2.7% in 2012. Our claims payment system, and your service billing, has, to date, been based on original rates and adjusted for the rate reduction.
- We will be implementing a process change in April 2014 to make this rate reduction on the front end of processing – thus the 2352 will reflect the adjusted rate, and your billing should reflect the 2352 rate. This is not an additional reduction, but rather a processing modification.
Questions? Please do not hesitate to contact us with any questions – call us at 800-322-3722 or email us at email@example.com.
Frequently Asked Questions:
How will billing work if there is a primary payer (insurance/school)?
Same as it works now. Both the new and old version of the 2352 states minus any nursing provided by insurance or school. Insurance/school hours are deducted from the RA using the HFS approved rate for the level of professional being utilized. All school and insurance hours must be billed to DSCC to apply to the monthly allocation.
If the SOC is not on the first of the month, will the hours be prorated? If so, how?
The RA is for a calendar month. It is not prorated.
How is the respite going to work since regular services are in dollars and respite in hours?
There could be instances when the remaining dollars do not allow us/HHA to bill in complete units. Same way it works today. Exhaust regular monthly RA before using respite as a fill-in.
If client is hospitalized, are dollars subtracted/day they are inpatient?
Will the new authorization process require the provider to bill monthly, or will they continue to bill weekly?
The provider should continue to bill weekly and split the billing at the end of the month.
Will the provider be able to bill on a standard UB04?
No- They must continue to use the DSCC Weekly Billing Form.
What rate should I use for billing?
They should bill with the reduced rate listed on the 2352 as of 04/06/14.
When will the new rates be effective?
As of 04/06/14 the reduced rates will be reflected on the new 2352. These rates should be billed on the weekly billing form to DSCC. No further reduction will be taken on the claim.
Questions? Please do not hesitate to contact us with any questions.