Wondering if anyone is dealing with this. We have a bill from
Medi Van that the client is a mode 5, however they didn’t transport as a mode
5, but a mode 4, so they can’t bill the state. Is it ok for us to pay the mode
4 rate and ask for that reimbursement?
The state says no, however, MediVan is claiming other counties
are doing it, they get the reimbursement then pay Medi Van. Are counties
billing for reimbursement before they pay the providers for the rides?
Thanks,
Steph
Stephani
Diekmann
Fiscal
Supervisor
Nobles
County Community Services Agency
507-295-5222
3 comments:
Janelle
The provider is correct in they must bill the level of service that is provided and that is not an option. It would be fraudulent for the provider to bill a “Mode 5 = Lift-equipped/ramp transport” (wheelchair transport) if that was not provided. It does not matter if the assisted transport is provided in a lift-equipped/ramp vehicle for they also tend to have seats for non-wheelchair riders.
It is possible the client will no longer need wheelchair certification and that may need to be ended and just “Mode 4 = Assisted transport” be the certification level. It may also be the client may need both spans to be available. It is not a waste of time or money to work with KEPRO on a resolution for this client. KEPRO may need to do an additional assessment for the Mode 4 transport certification but that is a one-time charge. KEPRO can at that time place a date span for a length of time or only a span when needed. This will not lead to additional charges for additional level-of-service (LOS) assessments but will require the client to call and let KEPRO know an assisted (Mode 4) span is needed for the specific date.
There are some issues currently with overlapping spans showing different levels of transport on the RSPC screen in MMIS which are being addressed. I will let you know what action we will be taking as quickly as possible.
Bob Ries
Minnesota Department of Human Services
Agency Policy Specialist
Medical Transportation & Interpreter Services
ph. 651.431.2485
fax 651.431.7426
Bob.Ries@state.mn.us
Also - our auditors frown on us getting reimbursed before we pay or providers :(
We do not submit claims until after we pay the provider (per Auditor's). We have had multiple issues with Medi-Van. Our transportation coordinator has allowed a Mod 5 person to be transported as Mod 4. She stated she has an email from Bob R. stating that is allowed.
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