DMAS Publishes New Patient Pay Guidance

The Department of Medical Assistance Services (DMAS) released a Provider Memo dated February 24th, 2015 addressing changes in the processing of patient pay amounts on long term care claims.  The memo can be found by clicking here and selecting 2015.  The memo states:  “Effective for dates of service on or after April 1, 2015, providers of long-term care services will not have to submit patient pay on claims.  The Medicaid Management Information System (MMIS) will access the patient pay from the MMIS and automatically reduce the final claims payment by the amount of patient pay.”

It is important to note that patient pay will be deducted on a first-in/first-out claims basis, as opposed to being assigned to a certain provider’s claims.  To the extent multiple providers provide the same services over a certain billing period, it is likely some reconciliation between providers might be required based on whose claims hit the system first.  For example, in a transfer situation, if the second provider happens to be a weekly biller, they may have the first-in/first-out claim and thus be reduced by the patient pay amount which at that point was likely collected by the first provider.

It is also important to note that the changes in how patient pay is processed do not necessarily apply to the three Medicare/Medicaid Plans (MMPs) under the Commonwealth Coordinated Care (CCC) program.  We strongly recommend you share this information, and the memo itself, with your relevant billing staff.