Get Hospice Reimbursement Invoice Nursing Facilities ... - Scdhhs.gov - Scdhhs

This guide provides clear instructions for completing the Hospice Reimbursement Invoice for Nursing Facilities, ensuring a smooth submission process. Follow the steps outlined below to accurately fill out each section of the form.

Follow the steps to complete the invoice successfully.

1. Click 'Get Form' button to obtain the form and open it in your editing tool.
2. Enter the facility name and the month for which the invoice is being submitted. Ensure that the correct year is indicated.
3. Fill in the Medicaid Provider ID number for the facility. This is essential for proper identification and processing.
4. Input the nursing facility's daily rate applicable for the billing period.
5. Specify the mailing address for the hospice and the corresponding Medicaid Provider ID number.
6. List the patient’s Medicaid number accurately to avoid delays in processing.
7. Indicate the level of care for the patient, selecting either TG for skilled or TF for intermediate care, according to SCDHHS Form 181 Section II Field 11.A.
8. Record the monthly recurring income amount for the patient, which may affect the total reimbursement.
9. Obtain the facility approval signature authority, ensuring that an authorized representative signs the document.
10. Enter the daily room and board rate for the hospice patient, as well as the total number of patient days billed.
11. Calculate the total amount due by multiplying the hospice patient daily room and board rate by the number of hospice days.
12. Ensure that the date of invoice submission is clearly noted. Verify that both the NF or ICF/MR ECF documentation is attached.
13. Once all information is accurately filled, save your changes, then download, print, or share the form as needed.

Start completing your Hospice Reimbursement Invoice online today to ensure timely processing.