PRRB/CMS Administrator Update
- May 07, 2021
The Medicare Administrative Contractor (MAC) disallowed the bad debt of Providers, long term care hospitals (LTCHs), based on the “must bill” policy, which requires a provider to bill the state Medicaid program and obtain a remittance advice (RA) for all claimed bad debt. The Board found that the Providers’ inability to obtain RAs from the states that did not allow enrollment of LTCHs in the Medicaid program qualified as an exception to the “must bill” policy. However, with respect to the other jurisdictions, the Board found that the exception was not applicable, because the Provider made the business decision not to apply for Medicaid certification in these states.
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