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UPL Q4 Interim Payment and COVID-19 add-ons - IHCA

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UPL Q4 Interim Payment and COVID-19 add-ons

Posted Sep 8, 20201 min Read

Payment & Reimbursement
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Two weeks ago,  the interim UPL payment calculations were released by Myers & Stauffer (M&S).  The Medicaid calculations included all three COVID-related add-ons, when applicable (4.2% was added for all and the 2% was added for COVID-Ready facilities).  The interim calculations also included an estimate of days paid for the COVID-Unit add-on.  The estimates are high and incorrect, which  will result in a higher Medicaid rate and therefore a smaller supplemental payment.  The reason they are in error is that M&S used data from ISDH as to the total number of residents in a COVID-unit regardless of payor source, because they don’t have payor source data, resulting in the inclusion of Medicare-paid days in the estimate.  During the year-end true-up, which is released in December and work begins on that in October, this will be corrected with actual claims data from the actual number of Medicaid residents in COVID-Units.  To get the data in order to calculate the true-up all claims for COVID-Unit payments through June 30, 2020 need to be submitted to Indiana Medicaid by September 30, 2020.  

About the Author

Elizabeth Eichhorn, Director of Reimbursement Policy and Payor Affairs