Ind. IHCP Hospice Services Provider Reference Module, Section 7, FSSA Recoupment From Nursing Facilities

The quarterly notification and recoupment process is as follows:

• The FSSA sends two different letters to nursing facility providers regarding the recoupment process:

➢ A letter providing written notification of the names of hospice members who are identified as

hospice on the quarterly minimum data set (MDS), but who are not enrolled in the IHCP hospice

benefit. The letter should also indicate the estimated amount of the overpayment.

➢ A letter that indicates an individual who is identified as hospice on the quarterly MDS, and who

is enrolled in the IHCP hospice benefit. The letter should also identify the amount of the IHCP

overpayment the nursing facility billed the IHCP for the dates of service the resident was under

hospice care.

• The NF is given 30 calendar days from receipt of the letter to respond to the FSSA in writing by

letter or fax.

• When the response time has elapsed, the FSSA proceeds with the formal recoupment process by

coordinating with the Claims Adjustment Unit.

• If there is not a recoupment issue based on the response received from the nursing facility, the FSSA

faxes a written notice to the nursing facility provider so that they have a copy for their

reimbursement records.

• If there is an IHCP recoupment from the nursing facility, the FSSA mails a formal notice to the

nursing facility provider referencing the original letter and specifying the name and Member ID of

the member who received the IHCP overpayment. The hospice provider also receives a copy of this

notice.