Date: August 29, 2022
To: Enrolled Hospice Agencies
Re: Hospice Nursing Home Room and Board Adjustments and Repayment
This notice is a follow-up to the May 28, 2021 provider notice regarding hospice patient claims for nursing home room and board charges that providers erroneously billed to the Department of Healthcare and Family Services (HFS) instead of the customer's HealthChoice Illinois (HCI) managed care organization (MCO) plan or the Managed Long Term Services and Supports (MLTSS) program.
HFS has recently voided the inappropriate hospice nursing home room and board payments. Providers will receive Remittance Advices identifying those adjustments to void (21C Adjustment Type). However, please be aware that the Adjustment Reason Code and message applied to the voids is incorrect; it is misidentified as 5018 - EAPG Paid at Zero.
HFS is providing data to the HCI MCO plans to expedite plan payments to providers based on the recoupments. Hospices are asked to work with the appropriate plan regarding any payments due.
Questions regarding this notice may be directed to the applicable HCI MCO plan.
Kelly Cunningham, Administrator
Division of Medical Programs