Providers eye payment delays

Personal care attendant (PCA) service providers around Minnesota are dealing with a payment delay for home and community-based services that could have serious consequences for small service providers. The payment delay affects claims submitted and scheduled to be paid for both the June 4 and June 18 payment dates. Some providers note that they will be hard-pressed to even cover a temporary or short delay, by being forced to dip into savings or take other measures to cover a possible shortfall. Some expressed surprise at the measure and what they saw as a lack of notice to plan.

The payment delays apply to services covered under Fee-for-Service (FFS) Medical Assistance. The payment delays also don’t apply to services provided through Minnesota Care or Medicare crossover claims. The Minnesota Department of Human Services notified providers recently telling them they must plan appropriately for this interruption in payment. The program won’t provide payment advances.

Minnesota Health Care Programs (MHCP) is required by law to delay payment for certain Medical Assistance services in June 2013. The law requires MHCP to delay payments normally made in June 2013 (the end of the fiscal year) until the first payment of July 2013. These payment delays apply to inpatient hospital services, non-hospital services, and Home and Community-Based Services (HCBS).

To comply with the requirements, MHCP will process payment delays by applying a reduction to fee-for- service (FFS) claims. The type of reduction and the payment dates affected depend on the service. It affects a multiple of services ranging from home care services to day training and habilitation.

MHCP will apply the delays to incoming claims only until reaching the required amount of savings, so some providers may not experience delays at all. Claims that are affected will pay zero.

MHCP will apply the delays on the second payment cycle of the month of June, which occurs on June 18, 2013. Providers will receive the delayed payments on the next payment cycle, July 2, 2013.

MHCP will report the reduction as a legislative cutback on the claim and will report Group/Adjustment Reason Code CO 45 on the remittance advice.

Anyone with questions may call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.