1. Lynn Nolf Estrada, Administrator Geriatric Dental Group of South Texas San Antonio, TX

2. Learning Objectives To understand who is eligible for each program To recognize the required forms needed for each program To understand the required processes for each program Recognize the pitfalls that can endanger the successful utilization of each program

3. Financial Options for Senior Care Form H1263-B Medicaid Process Full Vendor Program Self-pay

4. Form H1263-B Receive a completed Form H1263B from the nursing facility social worker You must have original signature of the MD, DO, NP, PA or Clinical nurse specialist on the first page The 2 nd page needs the signature of the resident or their responsible party (RP) The form must be entirely filled out. The resident must reside in and a licensed Nursing Facility

5. Business Manager Checklist Applied income Nursing Home Medicaid #14 effective date Medical POA or RP and their relation to the resident Who manages the funding/trust Spouse in the community Good standing with the facility Hospice

6. Verified Eligibility Contact the nurse and request the following: Face Sheet MARs (Medical Administration Resources) Advance Directive History & Physical Most recent lab work Set appointment with the nurse Courtesy call to the RP

7. Initial dental appointment Develop treatment plan based upon the findings from: Complete Oral Examination Full Mouth X-rays / Panorex Debridement

8. RP Consents Contact the Responsible Party for consents Treatment Plan Oral Surgery Consents Bisphosphonate Consents Sedation, etc Memorandum of Understanding

9. Completed Treatment Once the medically necessary treatment has been completed. Submit the claim to the Nursing Facility ME worker Mail original Form H1263-B Itemized Claim form of all completed treatment Date ADA Code Fee *Average processing time is about 30 to 45 days

10. Income Adjustment The ME worker approves treatment The adjustment is entered in the MESAV system The MESAV reflects the increase in funds available This notifies the nursing facility of an approval The practice will receive one or two forms showing the approval. This notifies us of the billing direction.

11. 3 possibilities for payments Form H1259 – Back-dated payments will come from the nursing facility Forms H1259 AND H4808 – a mixture of back-dated funds from the NF and future monthly payments from the fund manager Form H4808 – Payments to come in consecutive monthly intervals ** Form H1259 changing to H1053

12. Billing Form H1259 Bill the nursing facility Statement Itemized Invoice Copy of the 1259 Form H4808 Bill the Responsible Party Statement

13. Additional forms H1052-IME Action Needed Signatures missing Signature not original Description of signer Coding incorrect, etc H1054-IME Proof Needed Questionable treatment rendered. State requesting verification that treatment was received.

14. Full Vendor Program Eligibility There is no applied income (their SSI is =/< $60 per month) Nursing Facility Medicaid #14 Must be in dental pain Reside in a licensed Nursing Facility

15. Necessary Full Vendor Forms Form 2463 Physician Order stating “Dental Pain” Itemized invoice from the dental office ** There is a 1 year submission deadline.

16. Full Vendor fee schedule Dental Codes and Rates D0140Emergency Oral Exam$19.16 D9110Emergency Palliative Exam$18.75 D0220X-Rays First Exam$12.82 D0230X-Rays Second and Each Film$11.74 D7140Simple Extraction Single Tooth$67.04 D7250Extraction Root Removal – Exposed Roots$92.50 D7210Surgical Removal of Erupted Tooth$102.81 D7220Removal of Impacted Tooth-Soft Tissue$157.50 D7230Removal of Impacted Tooth – Partially Bony$180.00 D7240Removal of Impacted Tooth – Completely Bony$300.00 D7241Removal of Impacted Tooth – Completely Bony with Complications$156.25 D7250Surgical Removal of Resident Tooth Roots$92.50 D7510Incision and Drainage of Abscess-Intraoral Soft Tissue$37.50 D7520Incision and Drainage of Abscess-Exta oral Soft Tissue$125.00 D9215Local Anesthesia $12.50 D9220General Anesthesia – First 30 Minutes$87.50 D9221General Anesthesia – Each Additional 15 Minutes$31.25

17. Self Pay Resident has no Medicaid or the Medicaid is pending Work with the trust fund manager Credit card/checks CareCredit Once Medicaid is approved, if it is retro-dated, you can submit the Form H1263-B for their reimbursement

18. Thank you! Lynn Nolf Estrada, Administrator Phone: 210.617.4446 Fax: 210.617.5572 admin @ geriatricdentalgroup.com www.geriatricdentalgroup.com