Possible Amendment to Rules Governing Retroactive Billing

The Minnesota Department of Human Services requests comments on its proposed amendment to the rules governing retroactive billing for medical assistance providers and reimbursement of medical assistance recipients at part 9505.0540, subpart 3. Under the current rule, if a recipient was determined retroactively eligible for medical assistance, and has made payments to a provider for services received during a retroactive eligibility time period, the provider has the option of billing medical assistance and refunding the recipient, but only up to the amount paid by medical assistance. The proposed rules amendment would require providers to reimburse recipients for any amounts paid by a recipient for covered services during a retroactive period, regardless of whether the provider bills medical assistance or the amount paid by medical assistance. The amendment would also allow the recipient to appeal a provider’s failure to refund the recipient. The department believes that with the amendment the rules part will better align with federal requirements regarding retroactive coverage.

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INDUSTRY NEWS TAGS: Medicaid Minnesota

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