Date: May 28. 2021
To: Enrolled Hospice Agencies
Re: Hospice Nursing Home Room and Board N39 Rejections
This notice is a reminder to hospice agencies to bill the appropriate HealthChoice
Illinois managed care plan for managed care hospice patients’ nursing home room
and board charges. This includes room and board charges for customers enrolled
in the Managed Long Term Services and Supports (MLTSS) program.
Per informational notice dated September 20, 2018 and the IAMHP
Billing Guide, hospice agencies are
to bill the appropriate managed care plan for both the hospice services and
also nursing home room and board charges, if the patient is in managed care and
resides in a nursing facility. Some hospices have billed the Department
directly for nursing home room and board charges, and due to a system editing
issue, those claims were erroneously paid. The editing issue was fixed as of
March 30, 2021, and claims are now rejecting appropriately for the N39 - Recipient
in MCO-MMCP error code, if room and board charges for a managed care customer are
billed to the Department.
The Department and the managed care plans will internally reconcile the
inappropriate room and board payments made. No action is required by the
Questions regarding this notice may be directed to the applicable HealthChoice Illinois managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs