Legal

Do You Serve Individuals Eligible For Patient Liability?

By August 3, 2023January 12th, 2024No Comments

Are you reporting it to DODD correctly?

Are you getting reimbursed from the individual/family/guardian?

Patient Liability (PL) is defined in Ohio Administrative Code 5160:1-6-07.1 as a person’s “share of cost”.

PL is determined and calculated by the local county Department of Job and Family Services as part of the Medicaid eligibility determination process. DODD provides a list of people with Patient Liability–and the amounts–to each County Board of Developmental Disabilities. The County Board should share this information with applicable providers.

The assigned provider collects PL payments from the individual (or the individual’s guardian) and reports it to DODD through the submission of waiver claims in DODD’s Medicaid Billing System (eMBS).

Wonder why you are the provider chosen to be responsible for PL?

Generally, the provider who is authorized for most waiver services in the Payment Authorization for Waiver Services (PAWS) system is the provider who must collect Patient Liability payments.

Please note that all Patient Liability obligations must be met before any Medicaid funds may be billed. You are not just collecting the PL amount; you are charging the individual for the cost of services up to the PL amount. Then you can bill Medicaid through the Waiver.

We can help with Patient Liability and any other issues you are having with Medicaid billing. We can also help you find more revenue through our Billing Process Evaluation. Get in touch with our team!