Wis. ForwardHealth Online Handbook, Hospice, Topic #1128

For a Medicaid member receiving the hospice benefit who resides in a nursing home, the nursing home, hospice, and

ForwardHealth each play a role in collecting patient liability. Patient liability is the amount of an individual's income that is available

to apply on a monthly basis toward the member's cost of care.

Note: Patient liability does not apply to services provided to BadgerCare Plus members.

The nursing home is responsible for:

• Collecting patient liability from the Medicaid member residing in their facility.

• Transferring the patient liability amount to the member's hospice.

• Billing the hospice its contracted amount for room and board.

The hospice is responsible for:

• Paying the nursing home the contracted amount for room and board.

• Accepting as income the patient liability amount received from the nursing home. This amount will be automatically

deducted from claims submitted for the member.

• Indicating its usual and customary amount for nursing home room and board using revenue code 0169 for claims submitted

to ForwardHealth and submitting claims to ForwardHealth only once per calendar month.

ForwardHealth is responsible for:

• Deducting the patient liability, as reported to the state by the county, from the amount to be reimbursed to the hospice.

• Reimbursing the hospice 95% of the nursing home's SNF (skilled nursing facility) rate minus the patient's liability.

ForwardHealth automatically deducts the appropriate monthly patient liability amount from the first nursing home, hospice, or

long-term inpatient hospital claim received for the member. For example, a member is living in a nursing home for the month of

November but is admitted into an inpatient hospital for the last two days of the month. Both the nursing home and the inpatient

hospital submit a claim to ForwardHealth for that member for the month of November. ForwardHealth receives the claim from the

inpatient hospital first, so the patient liability is deducted from that claim because it was the first claim received for that member,

and from a case point of view, the member has 30 days in a facility. If the amount of patient liability exceeds the reimbursement

amount of the first claim, the remaining liability amount will be deducted from the next claim(s) received for services provided in

the month that patient liability is owed.

Patient liability amounts deducted from claims will appear in the providers' remittance information. Nursing home providers collect

the full monthly liability amount from the patient. They should work with hospice providers and inpatient hospital providers to

transfer the appropriate patient liability amount due to those providers.

If a paid claim is subsequently adjusted and denied, any liability amount originally deducted from the claim is returned to the

member's patient liability balance on ForwardHealth interChange. Patient liability will be deducted from the next institutional claim

paid for services provided in the month that patient liability is owed.

Retroactive Patient Liability Changes

If a member's patient liability decreases retroactively, ForwardHealth will change the member's file and adjust the paid claim as

appropriate.