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Payment & Reimbursement

Your Guide to Payment & Reimbursement Policy

Navigating payment and reimbursement policy for Indiana’s senior living sector.

Obtaining payment for the important services provided to Indiana’s elderly and disabled is critical to the success of communities and the hands-on care provided each and every day.  IHCA/INCAL has led the way in the development of Medicaid policy and advocacy, while AHCA/NCAL concentrates on policy and advocacy in the Medicare program, to help skilled nursing facilities and assisted living communities to receive compensation for their services.

CMS Releases Managed Care Prior Authorization Proposed Regulation

The Centers for Medicare and Medicaid Services (CMS) has reissued transmittal instructions for Medicare Administrative Contractors (MACs) to perform a 5-claim probe and educate medical review on every skilled nursing facility (SNF) in their jurisdiction. The purpose of this widespread review, which will be implemented in waves over the next year beginning June 5, 2023, is to lower the SNF improper payment rate. Providers should be on the lookout starting in early June for medical records requests related to this program.
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Medicaid

Indiana’s Case Mix reimbursement system is complex and frequently changing. We track and provide guidance on a range of matters from Quality Assessment Fee to Payment Add-ons to Value based Purchasing to Cost Reports and Audits.

We also engage in policy development and expansion of Medicaid Long Term Services and Supports, Medicaid Waiver and Home and Community Based Services.

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Medicare

The intersection of quality and payment in the Medicare program continues to advance at a rapid pace. We help members learn and adapt to these changes. Data and guidance on the Patient Driven Payment Model, SNF VBP, Quality Reporting Program, are available for members to access.

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I have appreciated the support of IHCA/INCAL for many years. Long-term and post-acute healthcare is complex and is constantly changing. The association provides a larger voice to the issues that plague our profession and hinder our ability to thrive. It also facilitates the needed tools, training and support for survival and success.

Mary Pankey RN HFA

Revenue Cycle Director , CarDon and Associates, Inc.

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IHCA/INCAL CONTACT

Elizabeth Eichhorn, eeichhorn@ihca.org 

Email Elizabeth