LeadingAge Iowa is a statewide membership organization of non-profit providers of aging services and supports and the champion for advancement and innovation in aging services. Our mission is to be the voice, support and connector for non-profit members and the people they serve. Our membership is diverse, representing the spectrum of non-profit long-term support and service providers including skilled nursing, assisted and independent living, PACE, home health, adult day, respite, hospice and home delivered meals.  Our members serve over 25,000 older adults in Iowa each day.

Amerigroup Provides Guidance on Processing Denials for LOC 

Amerigroup recently changed how they processed custodial NF and ICF claims based on the member’s level of care, as there were instances of claims paying when the member wasn’t actually approved for that level of care. 

An error occurred when changing this process, resulting in a high amount of inappropriate denials, PSO (not a covered benefit) for these claims. 

Amerigroup’s operation team reports that the  re-configuration project has been escalated and the reconfiguration solutions were completed on 1/18/19. At that point, all the old claims incorrectly processed with be reprocessed in a claims sweep and the new claims coming in should be processed correctly. Providers do NOT need to submit an appeal. The reconfiguration project will automatically address the inappropriate denials.  

Please contact Amerigroup for further questions.

PBJ Data Leads to New Off-Hour Survey Requirement 

On November 30th, 2018, the Centers for Medicare & Medicaid Services (CMS), Quality, Safety and Oversight Group(QSO), released QSO Memorandum, 19-02-NH, outlining updates to the Payroll Based Journal (PBJ) Policy Manual, notification to states on new survey requirements, and new Minimum Data Set (MDS) Census reports.  
The Memo announces that CMS will inform state survey agencies of facilities with potential staffing issues and require that states utilize that list to determine providers for off-hour surveys.  Using the new PBJ data, CMS will identify the following: 
  • Facilities with low staffing on the weekends
  • Facilities with several days in a quarter without an RN onsite 
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