What is a Fiscal Intermediary
Freedomcare functions as a Fiscal Intermediary (FI) that works as a middleman between consumers or their designated representatives and government programs like Medicaid and Medicare.
But what exactly is a Fiscal Intermediary? In this article we are going to break down everything you need to know about FIs. We will examine their responsibilities and how companies can apply to be one.
What is a Fiscal Intermediary (FI)?
FI’s are private companies that are contracted by Medicare or Medicaid to pay bills. In healthcare, a Fiscal Intermediary (FI) is a private company or another type of business entity that contracts with the U.S. government to process claims for programs like Medicare or Medicaid.
On the one hand, FI’s provide important written information and guidance to MDs, DPMs, and DOs about Medicaid or Medicare services and on the other hand, they make decisions about coverage and bill payments for things like hospital services. True to their name, they work as an intermediary between two parties that might otherwise struggle to communicate with each other.
Fiscal Intermediary Services Organizations (FISOs) are regulated by the Office of Insurance Regulation and they must meet certain requirements as a result. FISOs must go through a number of steps to become registered and authorized to provide services. The Department of Health in New York determines when and if a given FISO is permitted to collaborate with Managed Care Organizations and enter into contracts for CDPAP home care.
Once an FI becomes registered and qualified as an agency, they enter into a relationship with a government program such as Medicare or Medicaid. Their primary function is then to make payments to enrollees (or rather, consumers) according to the pertinent laws and regulations at the federal, state, and local levels to allow them to receive personal assistance services. As a consumer, your relationship with the FI agency allows you to choose your level of control over the recruitment, selection, management, training, and dismissal of a personal or home care assistant.
In summary, the FI works as a middleman between Medicaid or Medicare and consumers who wish to hire, train, and manage their own personal care assistant. For the consumer, the FI manages communication with Medicaid or Medicare. For the government program, the FI manages communication with the consumer and makes sure that the contractual agreement between both parties is being met through the proper distribution of funds for services rendered.
Responsibilities of the Fiscal Intermediary
Fiscal Intermediaries (FIs) must adhere to certain rules and regulations set forth by the U.S. government, the state of New York, and local laws. As a middleman, they have a contractual responsibility to both the consumer and to the government. Below are some of the most important responsibilities that FIs for the Consumer Directed Personal Assistance Program (CDPAP) must fulfill in the state of New York:
· FIs must process payments of wages and benefits for CDPAP personal assistants.
· FIs must establish each personal assistant’s wages and process all income tax and withholdings.
· FIs must comply with laws and requirements governing worker’s compensation, disability insurance, and unemployment insurance.
· FIs must establish that every CDPAP personal assistant is healthy according to certain standards pursuant to state regulations.
· FIs must monitor the consumer, or in some cases, the consumer’s designated representative to ensure they are fulfilling their responsibilities.
· FIs must stay in contact with consumers or their designated representatives to notify them of any emergent situation that’s relevant to their personal care.
· FIs must enter into and maintain an administrative agreement with the Department of Health or contract with Local Departments of Social Services to provide Consumer Directed Personal Assistant Services.
· FIs must ensure that consumers are in compliance with laws and regulations at the federal, state, and local levels.
Can anyone become a fiscal intermediary in NY?
In December 2019, New York mandated that all FIs who work with the CDPAP program must be joint employers in order to qualify. There are also some other specifications regarding the type of company or organization that is permitted to become an FI in New York. The types of institutions that may now be eligible to become FIs include:
· Service centers for independent living or Independent Living Centers (ILCs)
· An institution established as an FI before January 1st 2012 that has been continuously providing intermediary services to CDPAP consumers since that time
· Organizations (companies, non-profits, etc.) who are capable of providing the services required of FIs under the rules laid out by Social Services Law section 365-f.
So long as an organization is eligible to become an FI, they will be able to execute the next set of steps required to become a legally recognized provider. Keep in mind that a person cannot be an FI. The FI must be a legally recognized institution, such as a business, organization, non-profit, or similar business entity. In addition, only some applicants may be able to function as FIs as a part of the New York CDPAP program.
For eligible institutions, these are some of the steps involved with becoming an FI:
· First, you must contact the New York Department of Health (often referred to as “DOH” in official documents) for initial authorization. You will need to submit an application and a series of documents that support your claim that your institution is eligible to become an FI.
· When you are authorized to function as an FI, then you will need to contact the Bureau of Long Term Care Reimbursement so that you can open a Health Provider Network Account.
· The final step is for organizations and agencies that are not already a part of the Medicaid provider network. You will need to contact the Division of OHIP Operations at the Bureau of Provider Enrollment so that you can obtain a provider ID number.
After all of the above steps are completed successfully, it’s time for the new FI to obtain a contract with a Managed Care Organization (MCO) that provides CDPAP home care. The MCO and the FI will then be able to discuss the terms of the agreement in terms of the amount of reimbursement that’s needed. Remember that you will not be able to sign any agreements with an MCO until the Department of Health has reviewed your application and approved you to function as an intermediary. The Department of Health will not permit any agreements to occur between MCOs and unauthorized FIs.
Who is the best FI in the state of NY?
FreedomCare is the best and most widely utilized Fiscal Intermediary (FI) in New York State. We serve all 62 counties in New York, and since every county in New York also provides CDPAP services, we’re there to help no matter where you’re located in the state! We are also authorized to be an FI for both home health aides as well as personal care assistants for family and friends who are a part of the CDPAP program.
FreedomCare takes client care seriously. We provide our caregivers with an easy payment system and comparatively high starting pay rates in addition to a simple sign up system. We know how important it is for caregivers to be paid on time and to receive payments with ease so that they can continue providing the best care possible to their loved ones.
Our customer service team is friendly, personal, and ready to help with any issues that might arise. No matter your question, concern, or comment of appreciation, we’re ready to listen! If you’re looking for a compassionate and attentive FI option in New York State, FreedomCare is the best option to suit all of your needs.