Medicare Compliance & Reimbursement

A new missive from the feds helps clear up controversy about documentation You should have fewer headaches related to beneficiaries' low-income status in the coming months -- if you keep this tip sheet on hand. To clear up confusion about what constitutes acceptable documentation for a beneficiary's low-income status, the Centers for Medicare & Medicaid Services (CMS) issued a related guidance on Nov. 1. "Part D plans must accept any one of the following forms of evidence from beneficiaries or pharmacists to make a change to a beneficiary's low-income status," says CMS' Chris Worrall: • A copy of the member's Medicaid card which includes the member's name and an eligibility date during the discrepant period; • A report of contact including the date a verification call was made to the state Medicaid agency and the name, title and telephone number of the state staff person who verified the Medicaid status during the discrepant period; • A copy of a state document that confirms active Medicaid status during the discrepant period; • A printout from the state electronic enrollment file showing Medicaid status during the discrepant period; • A screen print from the state's Medicaid systems showing Medicaid status during the discrepant period; or • Other documentation provided by the state showing Medicaid status during the discrepant period. Don't forget verification: Part D plans must accept any one of the following forms of evidence from beneficiaries or pharmacists to establish that a beneficiary is institutionalized and qualifies for zero cost-sharing: • A remittance from the facility showing Medicaid payment for a full calendar month for that individual during the discrepant period; • A copy of a state document that confirms Medicaid payment to the facility for a full calendar month on behalf of the individual; or • A screen print from the state's Medicaid systems showing that individual's institutional status based on at least a full calendar month stay for Medicaid payment purposes during the discrepant period. CMS will be closely monitoring Part D plan compliance with the new policy, says Worrall.