In This Issue. Information Releases

Transcription

1 An Informational Newsletter for Idaho Medicaid Providers From the Idaho Department of Health and Welfare, July 2013 Division of Medicaid In This Issue Billing claims with date of service before 10/01/14 after ICD-10 implementation... 1 Tips for Primary Care Providers on Tobacco Cessation... 1 Do Your Patients Need to Lose or Gain Weight?... 2 Medicaid Program Integrity Unit... 2 Electronic Health Records Incentives... 3 Electronic Health Records Incentives (Cont)... 4 Overlapping Psychosocial Rehabilitation and Psychotherapy... 4 Provider Training Opportunities in July...20 Prior Authorization Contact Information...24 Transportation...24 DHW Resource and Contact Information...25 Insurance Verification...25 Molina Provider and Participant Services Contact Information...26 Molina Provider Services Fax Numbers...26 Information Releases MA13-10 Home Health Medicaid Caps... 5 MA13-11 Implementation of Idaho Behavioral Health Plan (IBHP)... 6 MA13-12 Preferred Agents for Drug Classes Reviewed at Pharmacy and Therapeutics Comittee... 9

2 Billing claims with date of service before 10/01/14 after ICD-10 implementation With the October 1, 2014, ICD-10 deadline approaching, you may be wondering how you will code a claim that you are submitting in October 2014 for a service that your practice provided in September Even if you submit your claim on or after the ICD-10 deadline, if the date of service was before the October 1, 2014, deadline, you will use ICD-9 to code the diagnosis. For dates of service on or after the October 1, 2014, deadline, you will use ICD-10. You will not be able to use ICD-9 and ICD-10 codes on the same claim. This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD-9 diagnosis codes for services provided before October 1, 2014, and another claim with ICD-10 diagnosis codes for services provided on or after October 1, For more information regarding split billing see related CMS guidance at: Tips for Primary Care Providers on Tobacco Cessation The Preventive Health Assistance (PHA) benefit provides assistance to participants to help them quit using tobacco. Medicaid provides assistance to: Locate cessation programs Pay for prescription and over the counter cessation products such as: Prescription medication, inhalers, nasal spray, patches, lozenges or gum. Idaho Medicaid Recommends Following the Surgeon General s 5 A Approach 1. Ask Systematically identify all tobacco users at every visit. 2. Advise Strongly urge all tobacco users to quit. 3. Assess Determine willingness to make a quit attempt. 4. Assist Aid the patient in quitting. 5. Arrange Schedule a follow up and refer your Medicaid patients to the PHA Unit at our toll free number, 1 (877) , or give them a PHA brochure. If you would like to request a supply of PHA brochures or if you would like more information on PHA benefits, please call the PHA Unit at 1 (877) Go to to obtain the entire Quick Reference Guide for Clinicians Treating Tobacco Use and Dependence. Please note: Cessation products are not covered under the Medicaid Pharmacy program. They are only available through the PHA program authorization process. MedicAide July 2013 Page 1 of 26

3 Do Your Patients Need to Lose or Gain Weight? The Preventive Health Assistance (PHA) benefit may be able to help pay for a weight management program. PHA provides assistance to Medicaid patients who meet the Centers for Disease Control definition of being obese or underweight. To qualify for this benefit, Medicaid patients must: be over the age of 5 have a Body Mass Index (BMI) in the obese or underweight range, and want to improve health through weight management. If you have a patient you think may qualify, please give them a PHA brochure or refer them to the PHA Unit at If you would like to request a supply of PHA brochures or if you would like more information on PHA benefits, please call the PHA Unit at (toll-free). Medicaid Fraud Control Unit Idaho Home Health Provider Convicted of Petit Theft On June 14, 2013, Juvenal Carrillo, Jr., a Nampa, Idaho home health provider, was convicted of petit theft for submitting fraudulent claims for attendant care and homemaker services. Carrillo was sentenced to 30 days in jail, and was ordered to pay $ in combined restitution to the Idaho Department of Health & Welfare, Division of Medicaid, to the Office of the Idaho Attorney General, as well as to his employer, a local personal assistance service agency. Carrillo submitted falsified progress notes to his employer. The employer learned of the allegations, and reported the activity to the Office of the Idaho Attorney General, Medicaid Fraud Control Unit. MedicAide July 2013 Page 2 of 26

4 Electronic Health Records Incentives The Idaho Department of Health & Welfare will launch the Idaho Medicaid Electronic Health Record (EHR) Incentive Program for Stage 1 Meaningful Use on July 1, Eligible Professionals (EPs) and Eligible Hospitals (EHs) can receive an incentive payment for meeting the requirements of Stage 1 Meaningful Use as well as for adopting, implementing, or upgrading a certified EHR technology. The Medicaid EHR Incentive Program will run through In order to receive full payment all eligible providers must initiate the application/attestation for an incentive payment from Medicaid by For more information on who is eligible or how to access the program, please go to the Idaho Medicaid EHR Incentive Program website at Providers are encouraged to utilize the resources listed there to determine if they are eligible for an incentive payment and to learn the details of the application/attestation process where appropriate. EPs and EHs must first register at the Centers for Medicare and Medicaid Services (CMS) Registration and Attestation (R&A) site ( Providers can register to receive a Medicaid EHR incentive payment from Idaho Medicaid which is the first step in the application/attestation process. Idaho has an interface to this website in place and will receive the registration information from CMS after it is completed. Once registration is received and reviewed by Idaho Medicaid, staff will initiate contact with the registrant via directing you to proceed to our Idaho Incentive Management System (IIMS) to complete the Idaho application/attestation portion of the process at We encourage you to visit the CMS website at to learn how to register with the CMS Registration and Attestation System. There you will find a user s guide on how to complete the CMS registration step. The CMS site also has a wealth of information about the Medicare and Medicaid EHR Incentive Programs. Also, please visit the Idaho Medicaid EHR Program website at for additional information about the Idaho Medicaid EHR Incentive Program. Check out the Informational Papers posted there under Educational & Training Materials. The presentations on AIU and Stage 1 meaningful use are available on our website. There is an Ask the Program feature where you can send an directly to our EHR Program staff if you have any questions. Also available is an option to subscribe to receive Updates notifying you when the website has been updated. Important steps providers should review in preparation to participate in the Idaho Medicaid EHR Incentive Program: 1) Determine if you are eligible for either the Medicare or Medicaid EHR Incentive Programs. Eligibility guidelines are available on the CMS website at 2) Eligible professionals need to decide whether to apply for Medicare or Medicaid incentives. CMS has information and a Decision Tool available on their website to assist eligible providers. Eligible hospitals may qualify for both Medicare and Medicaid incentive payments. 3) Eligible hospitals applying for both Medicare and Medicaid incentive payments must be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS). Verify PECOS enrollment information on the CMS website. 4) Confirm that you have an active NPI number. Visit the NPPES website for more information. MedicAide July 2013 Page 3 of 26

5 Electronic Health Records Incentives (Cont) 5) Verify that your EHR technology meets certification requirements. There is a list of EHR systems that meet the requirements on the ONC website at 6) The recipient of the EHR Incentive Program payment must be registered as a Vendor with the State of Idaho. If the EP is receiving the payment directly, that EP must be a vendor. If the EP is reassigning the payment to the clinic, the clinic must be a vendor. If you are unsure if you are already a vendor, please call the EHR help desk at 1 (208) , or see the guide on how to become a vendor on our Idaho EHR website. Questions may be directed to the Idaho EHR Program staff by sending an to EHRIncentives@dhw.idaho.gov or by phone at 1 (208) Medicaid Program Integrity: Overlapping Psychosocial Rehabilitation and Psychotherapy Recent audits of psychosocial rehabilitation service (PSR) providers have revealed instances where Idaho Medicaid was billed for PSR at the same time the participant was receiving individual psychotherapy. Reimbursement is not allowed for PSR services provided during the time the participant is in a psychotherapy session. The Current Procedural Terminology, 2013 edition, defines psychotherapy as the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. PSR consists of skill training and community reintegration. PSR and psychotherapy are different services, and require different qualifications to provide them. Only one service will be reimbursed during a single time period. The Department will recover payments and assess civil monetary penalties to providers billing for PSR services billed while participants are in psychotherapy sessions. MedicAide July 2013 Page 4 of 26

6 MA13-10 Home Health Medicaid Caps MedicAide July 2013 Page 5 of 26

7 MA23-11 Implementation of Idaho Behavioral Health Plan (IBHP) MedicAide July 2013 Page 6 of 26

8 MedicAide July 2013 Page 7 of 26

9 MedicAide July 2013 Page 8 of 26

10 MA33-12 Preferred Agents for Drug Classes Reviewed at Pharmacy and Therapeutics Comittee MedicAide July 2013 Page 9 of 26

11 MedicAide July 2013 Page 10 of 26

12 MedicAide July 2013 Page 11 of 26

13 MedicAide July 2013 Page 12 of 26

14 MedicAide July 2013 Page 13 of 26

15 MedicAide July 2013 Page 14 of 26

16 MedicAide July 2013 Page 15 of 26

17 MedicAide July 2013 Page 16 of 26

18 MedicAide July 2013 Page 17 of 26

19 MedicAide July 2013 Page 18 of 26

20 MedicAide July 2013 Page 19 of 26

21 MedicAide July 2013 Page 20 of 26

22 MedicAide July 2013 Page 21 of 26

23 MedicAide July 2013 Page 22 of 26

24 Provider Training Opportunities in July You are invited to attend the following webinars offered by Molina Medicaid Solutions Regional Provider Relations Consultants. ICD-10 Preparedness A guide of preparedness suggestions and key points to ensure you are on track to be ready for the 2014 implementation. Top Claim Edits A presentation of current Edits that are most frequently generated during provider claims submission. Training is delivered at the times shown in the table below. Each session is open to any region but space is limited to 25 participants per session, so please choose the session that works best with your schedule. Date New Provider Enrollment and Provider Maintenance Training 07/08/ :00 A.M. MT 07/10/ :00 A.M. MT 07/15/ :00 A.M. MT 07/16/ :00 A.M. MT & 2:00 P.M. MT 07/18/ :00 A.M. MT & 2:00 P.M. MT Register to create your one-time user profile Click on Idaho Medicaid Training Center 1. Create your user name A minimum of eight characters Must contain letters, numbers, and special characters 2. Create your password A minimum of eight characters Must contain at least one upper case letter, one lower case letter, one number, and one special character (@, #, $, %, ^, *, +, -) 3. Obtain the access code You must call 1 (866) to obtain your Access Code If you need assistance registering for this class contact idedisupport@molinahealthcare.com If you would prefer one on one training in your office with your Regional Provider Relations Consultant please feel free to contact them directly. Provider Relations Consultant Contact Information Region 1 and State of Washington Dianna Adams Region.1@MolinaHealthCare.com (208) Region 2 and State of Montana Kristi Irby Region.2@MolinaHealthCare.com (208) Region 3 and State of Oregon Rainy Natal Region.3@MolinaHealthcare.com (208) Region 4 and all other states Debbie Schiller Region.4@MolinaHealthCare.com (208) Region 5 and State of Nevada Brenda Rasmussen Region.5@MolinaHealthcare.com (208) Region 6 and State of Utah Kelsey Gudmunson Region.6@MolinaHealthCare.com (208) Region 7 and State of Wyoming Kristi Harris Region.7@MolinaHealthCare.com (208) MedicAide July 2013 Page 23 of 26

25 Prior Authorization Contact Information Please use these numbers to submit prior authorization requests to Medicaid or to communicate with Medicaid staff regarding details of prior authorization requests. For questions regarding claims with an existing prior authorization, please call Provider Services at 1 (866) DME Specialist, Medical Care P.O. Box Boise, ID Pharmacy P.O. Box Boise, ID Medical Care Attention: Surgery Authorizations P.O. Box Boise, ID Qualis Health (Inpatient hospital stays greater than three days and selected diagnoses & procedures, Telephonic & Retrospective Reviews) Meridian Avenue N., Ste 100 PO Box Seattle, WA Preventive Health Assistance PHA Unit P.O. Box Boise, ID Office of Mental Health and Substance Abuse (OMHSA) P.O. Box Boise, ID (866) Fax: 1 (877) (Attn: DME Specialist) 1 (866) Fax: 1 (800) (208) Fax: 1 (877) (800) (206) Fax: 1 (800) (877) (208) Fax: 1 (877) (208) (866) Fax: 1 (888) Transportation Idaho Medicaid contracts with American Medical Response (AMR) for all non-emergency medical transportation services. Please go to or call 1 (877) for more information. Ambulance Review 1 (800) (208) Fax: 1 (877) MedicAide July 2013 Page 24 of 26

26 DHW Resource and Contact Information DHW Web site Idaho CareLine (800) Medicaid Program Integrity Unit P.O. Box Boise, ID prvfraud@dhw.idaho.gov Fax: 1 (208) Healthy Connections Regional Health Resource Coordinators Region I Coeur d'alene Region II Lewiston Region III Caldwell Region IV Boise Region V Twin Falls Region VI Pocatello Region VII Idaho Falls In Spanish (en Español) 1 (208) (800) (208) (800) (208) (208) (800) (208) (208) (800) (208) (800) (208) (800) (208) (800) (800) Insurance Verification HMS PO Box 2894 Boise, ID (800) (208) Fax: 1 (208) MedicAide July 2013 Page 25 of 26

27 Molina Provider and Participant Services Contact Information Provider Services MACS (Medicaid Automated Customer Service) Provider Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT Mail Participant Services MACS (Medicaid Automated Customer Service) Participant Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT Mail Participant Correspondence Medicaid Claims Utilization Management/Case Management CMS 1500 Professional UB-04 Institutional UB-04 Institutional Crossover/CMS 1500/Third-Party Recovery (TPR) Financial/ADA 2006 Dental 1 (866) (208) (866) (208) idproviderservices@molinahealthcare.com idproviderenrollment@molinahealthcare.com P.O. Box Boise, ID (866) (208) (866) (208) idparticipantservices@molinahealthcare.com P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID Molina Provider Services Fax Numbers Provider Enrollment 1 (877) Provider and Participant Services 1 (877) MedicAide July 2013 Page 26 of 26

28 Provider Relations Consultant (PRC) Information Region 1 and the state of Washington Dianna Adams 120 Ironwood Drive Suite 102 Coeur d Alene, ID (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana Kristi Irby 1118 F Street P.O. Box Drawer B Lewiston, ID (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon Rainy Natal 3402 Franklin Caldwell, ID (208) Region.3@MolinaHealthCare.com Region 4 and all other states Deb Schiller 1720 Westgate Drive, Suite A Boise, ID (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada Brenda Rasmussen 803 Harrison St. Twin Falls, ID (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah Kelsey Gudmunson 1070 Hiline Road Pocatello, ID (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming Kristi Harris 150 Shoup Avenue Idaho Falls, ID (208) Region.7@MolinaHealthCare.com MedicAide July 2013 Page 27 of 26

29 Molina Medicaid Solutions PO Box Boise, Idaho Digital Edition MedicAide is available online by the fifth of each month at There may be occasional exceptions to the availability date as a result of special circumstances. The electronic edition reduces costs and provides links to important forms and websites. To request a paper copy, please call 1 (866) MedicAide is the monthly informational newsletter for Idaho Medicaid providers. Editors: Shelby Spangler and Shannon Tolman If you have any comments or suggestions, please send them to: Shelby Spangler, spangles@dhw.idaho.gov Shannon Tolman, tolmans@dhw.idaho.gov Medicaid - Communications Team P.O. Box Boise, ID Fax: (208) MedicAide July 2013 Page 28 of 26