Attention Section 67, Nursing Facility (NF) Providers: Implementation of NF Reform Billing Changes
The Department implemented reformed rates for NFs.
Billing Guidance
Claims for dates of service starting on, or after January 1, 2025, should be submitted according to the billing guidance that was shared in the January 10, 2025 notice.
Upcoming NF Forum: February 6, 2025
NF Minimum Data Set (MDS) forum offers an additional opportunity to ask questions on the new Patient Driven Payment Model (PDPM). If interested, please register at the following Zoom link: Meeting Registration - Zoom
Correction to NF Rate Letters
MaineCare corrected an error in Code AAAA6 that included a third decimal place in the PDPM weights in the table of the rate letters. The PDPM weights are limited to two decimal places to align with the format of the Centers for Medicare & Medicaid Services (CMS) PDPM weights on which the MaineCare PDPM weights are based. Updated rate letters are now available on the secure Health PAS Online Portal.
Resources
- Recordings of the Open Office Hours for providers, billers and/or vendors from January 16 and January 28, 2025
- Facility-specific assessment reports submitted to CMS between October 1, 2024, and December 31, 2024, can be accessed by logging into the Submission Management System (SMS). Please contact Catherine.Gunn@maine.edu if you need assistance with your username and password.
- PDPM case mix weights (PDF)
The following resources will soon be posted to the Rate System Reform webpage:
- PDPM Billing FAQ
- Updated UB04 Billing Guide
Contact Information
- For case mix or PDPM questions please contact Sue Pinette, Case Mix Manager and Resident Assessment Instrument (RAI) Coordinator.
- If you have additional questions, please contact Bruce Cosgrove, Provider Relations Specialist.