The Department of Health Care Services today posted the final 2014-15 Medi-Cal reimbursement rates for freestanding skilled-nursing and freestanding subacute providers under Assembly Bill 1629.
The rates are effective retroactively to Aug. 1, 2014. In addition, the freestanding subacute rates for the 2013-14 rates year have been corrected for selected facilities in which rates were computed in error.
DHCS has said that it will take 60 to 90 days to update the Medi-Cal claims system to pay these rates. All claims paid at the prior per diem reimbursement will be reprocessed for retroactive rate adjustment through an erroneous payment correction (EPC), which will be initiated six to nine months after the rate information is updated in the payment system.
When the EPC is processed, overpayments will be recouped by reducing subsequent checkwrites by 5 percent until the overpayment is paid in full. DHCS will notify providers when the EPC is processed.
The notification will also provide additional information to make other arrangements for recoupment of overpayments. Please note that the EPC to collect overpayments for the 2013-14 rate year has not been installed, and DHCS cannot provide a date for installation.
DHCS has not yet posted instructions to begin billing the final rates but will issue a provider bulletin to that effect once the rates are in the system. SNFs may start billing new rates now, and the system will pay either the amount billed or the rate on file, whichever is less.
QA fees for 2014-15
The updated invoices for payment of the QA fee have been posted on the DHCS website.
The quality-assurance fee has increased to $16.03 for facilities with fewer than 100,000 patient days per year and to $15.15 for facilities with 100,000 or more patient days.
The incremental increase in the QA fee does not have to be paid to DHCS until a facility’s rates have been adjusted to include the new fee. Staff contact: Nancy E. Hayward, 916-432-5204, email@example.com.