Finance and Operations
Medicare
With more and more older adults finding health care outside of the hospital setting, knowing as much as possible about Medicare is more important than ever. An in-depth knowledge helps you serve your patients and make sure you’re getting the Medicare funds you need.
Medicare articles called MLN Matters are produced by CMS and explain policy and procedures. See the archive for all published MLN Articles.
NGS is a processor of Medicare claims for Illinois FQHCs. The NGS Website for FQHCs contains provider notices, production alerts for electronic claims systems, appeals process, training manuals, workshops, and webinars.
All providers required to file a Medicare cost report are required to submit their cost report within five months of the cost reporting fiscal year end, or 30 days after a valid provider statistical and reimbursement (PS&R) report is sent to the provider by National Government Services—whichever is later. Information about the report is available on the NGS Cost Reports webpage. Instructions for the Medicare cost report are available on the CMS paper based manuals website. For FQHC reports with fiscal year ending 9/30/2015 and beyond the Medicare FQHC PPS Cost Reports are now on CMS-224-14 form. The new form and instructions are available on the CMS website.
Chapter 13 describes the Medicare services and providers specific to FQHCs.
Chapter 15 includes covered medical and other health benefit services for eligible beneficiaries. This is useful when dealing with Part B services.
Chapter 1 includes general billing requirements such as provider assignment to FIs and MACs, provider participation, etc.
Chapter 9 details FQHC policies, payment methodology, allowable costs, annual cost report reconciliation, etc.
Chapter 18 indicates coding and payment for preventive and screening services.
Chapter 25 defines the CMS-1450 data set (UB-04) data elements
IPHCA staff is able to assist members with questions regarding Medicare billing, cost reporting and rates. Contact Susan Gaines at (217) 541-7409 or [email protected].
Illinois Medicaid Transition
As part of the new Medicaid MCO contract, the Illinois Department of Healthcare and Family Services will be using IMPACT information to credential providers during the Medicaid provider enrollment and update process. This will replace the prior credentialing required by each Medicaid Managed Care Plan in Illinois. You may have already noticed a new question during the IMPACT enrollment of a provider. The new question is located on the enrollment checklist inquiring the status of the provider’s liability insurance and policy coverage limit insurance. The Bureau of Primary Health Care suggests deemed providers respond to the question as follows:
Name of Insurer:
Health Resources and Service Administration (HRSA)
5600 Fishers Lane, Rockville, MD 20852
Coverage Amount:
No Cap
For more information, please contact Susan Gaines, Vice President of Community Development + Financial Services