Preparing for the Upcoming Fiscal Year 2016 Fee-for-Service Claims Billing Closeout
It is important for providers to promptly submit claims to be paid by the Texas Department of Aging and Disability Services (DADS) for any unbilled services to prepare for the August 31, 2016, end of the state fiscal year. DADS will publish additional details regarding cutoff dates for fiscal year 2016 in an upcoming DADS information letter when they are available.
•12-month filing rule – Providers should ensure not only that billing is current for all services provided, but also that any problems associated with the claims are resolved within the12-month filing limitation.
•Remittance & Status (R&S) reports – Especially as the new state fiscal year approaches, providers should be particularly diligent in reviewing their R&S reports to ensure recoupments on claims paid by DADS are valid. Any invalid recoupments for fiscal year 2014 services (services provided September 1, 2013, through August 31, 2014) should immediately be brought to the attention of state office staff listed at the end of this letter so providers can rebill for these services prior to this year’s August cutoff date for submitting claims. If rebilled after the August cutoff date, the claim becomes a “miscellaneous claim.”
•Miscellaneous Fee-for-Service claims – Miscellaneous claims occur when the service dates are earlier than two prior fiscal years plus the current fiscal year. Claims for services that are less than eight years old and/or claims that total less than $50,000 owed to a single legal entity are paid on a first-come, first-served basis using funds appropriated during each legislative session. Miscellaneous claims over $50,000 and/or for services more than eight years old cannot be paid except as a special line item in the state budget.
See the In This Corner feature of the May 2016 LTC Provider Bulletin, which includes information for avoiding miscellaneous claims.
Invalid or inappropriate recoupments should be immediately reported to DADS Provider Claims Services at (512) 438-2200, Option 3.
For questions about the R&S report, please contact the Texas Medicaid & Healthcare Partnership at 1-800-626-4117, Option 1.
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