Billing Changes Effective Thurs., December 12, 2024
In early November, we attended a Fiscal Intermediary Contract Webinar presented by OPWDD. As a result of the webinar, we chose to update our date of service definition.
As of December 12, 2024, the date of service is defined as the date the Fiscal Intermediary reimburses the person or their representative - rather than the date the service takes place.
What is changing?
- All direct-paid or reimbursed dollar-based expenses (IDGS, OTPS, FRR, Over PRA, and Existing IDGS) paid after December 12, 2024, will have their Date of Service calculated based on the date the Fiscal Intermediary reimburses the expense.
i.e. an October Mileage reimbursement for IDGS: Transportation paid on December 15th will be shown in December on the budget summary and claimed to Medicaid on December 15th. - Presently, Housing Subsidy is the only expense pre-paid by ISS. The Housing Subsidy date of service will continue to be the month the Housing Subsidy covers.
i.e. a January rent payment, paid on December 23rd will be shown in January on the budget summary and claimed to OPWDD on January’s voucher - If, in the future, ISS were to prepay or pre-reimburse any other type of expense, the date of service would be the date of the receipt of the good or service.
What is not changing?
To meet the mandate of “timely vouchering for reimbursement” and “good judgment and business practices”, ISS will continue to expect the request for payment or reimbursement no later than the last day of the month following the date the service takes place.
i.e. for a good or service that occurred in the month of October, ISS expects a request for payment or reimbursement no later than the last day of November.
Self-Hired Staff and Brokerage is NOT affected. For these services, the Date of Service will continue to be the date on which the staff or broker provided the service directly to or on behalf of the participant. To ensure timely payment and timely filing of claims, Brokers must submit their invoice to ISS for payment no later than the last day of the month following their service.
We will continue to process reimbursement requests in the order they are received. We will continue to require the information regarding when the service took place.
i.e. We need to know the dates the Family Reimbursed Respite took place, so we can confirm there is no overlap with other services such as Self Hired Com Hab
There is currently no change in the documentation required. There is currently no change in how you upload expenses or the information required when uploading expenses.
How does this benefit me?
- By carefully aligning our policies and practices with the rules and expectations of OPWDD, ISS is ensuring our ability to continue to provide the best possible person-centered experience for our stakeholders.
- This change allows extra flexibility to resolve documentation and budget challenges. Since ISS’s timely filing timeframe begins upon request to reimburse an expense, there is additional time available to resolve any concerns around backup documentation, budgetary efficacy, or other challenges. This should limit the expenses that are denied or unable to be reimbursed.
What will I see differently?
Reimbursement requests for services delivered in the September - November timeframe paid after December 12, 2024, will appear in the month of payment, which is December.
i.e. An October Family Reimbursed Respite expense paid on December 15th will show on the budget summary in the month of December, not October as before.
The net result will be an approximately 2-month shift forward in how reimbursements are displayed on the budget summary. We expect concerns around the exhaustion of budget lines due to this shift should be limited as next year's expenses will continue to be dated based on the date paid.
If there is a specific challenge caused by this change, please reach out to your SDC to discuss. We will do our best to reach a favorable resolution.
Created 12/31/24.