A patient was admitted as an inpatient into our acute facility and had an HMO Medicare Advantage plan that termed one week after admission. Is the MA plan liable for the entire inpatient stay?
If the patient is a member of a Medicare Advantage (MA) Organization for only a portion of the billing period two factors determine whether the MA organization is liable for payment: • Determine whether the provider is included in the inpatient hospital or home health PPS. • Verify the date of enrollment. If the provider is an acute care hospital, inpatient rehab facility or a Long Term Care Hospital (LTCH), and the patient changes MA status during an inpatient stay at an inpatient institution, the patient’s status at admission or start of care determines liability. If the hospital inpatient was not an MA enrollee upon admission but enrolls before discharge, the MA Organization is not responsible for payment. For hospitals exempt from PPS, if the MA organization has processing jurisdiction for the MA involved portion of the bill, it will direct the provider to split the bill and send the appropriate portions to the appropriate FI or MA organization. If the provider is not a PPS provide
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