ICD-10/APR-DRG. HP Provider Relations/September 2015
|
|
- Shannon Shields
- 5 years ago
- Views:
Transcription
1 ICD-10/APR-DRG HP Provider Relations/September 2015
2 Agenda ICD-10 ICD-10 General Overview Who is affected Preparation Testing Prior Authorization APR-DRG Inpatient hospital rates Crosswalks Questions 2
3 ICD-10
4 ICD-10 Overview The U.S. Department of Health and Human Services (HHS) has issued a final rule establishing October 1, 2015, as the new compliance date for healthcare providers, health plans, and healthcare clearinghouses to transition to International Classification of Diseases 10 Revision (ICD-10) ICD-10 was adopted by the World Health Organization (WHO) in 1990 and is used in many other countries ICD-10 provides for a greater level of detail in reporting The IHCP has continued its system remediation and internal and external testing The IHCP will implement ICD-10 in compliance with the CMS effective date of October 1,
5 ICD-10 General Overview ICD-10 codes may be up to seven alphanumeric characters as compared to the five alphanumeric characters for ICD-9 Coding to the highest level of specificity is still required. Use three character code ONLY if it is not further subdivided, codes without all required characters are invalid. Alpha character is NOT case-sensitive Digits contain intelligence, category, etiology, anatomical site, severity, and so forth Some codes may contain an X placeholder in the fifth and/or sixth position 5
6 ICD-10 General Overview Invalid ICD-10 code factors May not be coded to the highest level of specificity not enough digits Code may require a seventh character 6
7 Who Is Affected by ICD-10? If you are currently required to use ICD-9 diagnosis codes on your claims, you will be required to use ICD-10 codes on claims for dates of service on or after October 1, 2015 Dental and non-dme pharmacy claims are the only claims not affected by the implementation of ICD-10 at this time 7
8 What Should Providers do to Prepare Staff? The CMS Provider Resources web page offers several guides for providers and their staff Although certified coders will not need to be recertified for ICD-10, their skills need to be assessed for ICD-10, and continuing education unit (CEU) requirements will change Credentialing organizations supply this information on their websites Other areas of training to consider include: Staff training in clinical documentation and charting Updating your super-bill and charge-slip and the associated processes Revising patient questionnaires and reasons for visit to accurately reflect ICD-10-related information needs Evaluating and updating electronic health records (EHR) to reflect ICD-10 information needs 8
9 Systems and Testing Review file layouts to ensure your system can accommodate the additional code length Conduct testing with your vendors and clearinghouses Conduct testing with payers 9
10 Updated Prior Authorization Process The implementation of ICD-10 required the IHCP to update the Indiana Prior Authorization Request form to remove the reference to ICD-9 and increase the field length for diagnosis codes Providers will continue to use the Indiana Health Coverage Programs Prior Authorization Request Form (universal PA form), which is available on the Forms page at indianamedicaid.com 10
11 Updated Prior Authorization Process The ICD codes used when completing a PA request will be determined by the start date of service associated with the request Providers should follow these requirements: Existing PAs with START DATES OF SERVICE that began before October 1, 2015, but extend beyond that date, will not be affected; no additional action will be required New PAs with START DATES OF SERVICE on or before September 30, 2015, will require only ICD-9-CM diagnosis codes, as outlined in the current process New PAs with START DATES OF SERVICE on or after October 1, 2015, will require only ICD-10-CM diagnosis codes Providers should NOT submit PA request forms with ICD-9 and ICD-10 diagnosis codes on the same form; separate request forms are required 11
12 Updated Prior Authorization Process Effective August 1, 2015, providers began submitting PA requests with start dates of service on or after October 1, 2015, using ICD-10 diagnosis codes Note that claims processing is not affected by the diagnosis code entered on the PA request 12
13 Medical Policy The IHCP has cross-walked the ICD-9 codes to ICD-10 codes for policy areas where coverage is restricted or specific billing instructions have been established See the Span-Date information to determine whether to use ICD-9 or ICD-10 codes Providers are responsible for billing the appropriate code with the highest level of specificity for the member s diagnosis, unless otherwise instructed IHCP policy and related billing guidance, other than the crosswalk to ICD-10 codes as described, remains unchanged 13
14 Medical Policy The Medical Policy Manual has been updated to reflect ICD-10 codes associated with IHCP coverage policies The updated policy manual will have an effective date of October 1, 2015, and will be posted on the Manuals page at indianamedicaid.com on or before October 1, 2015 The Medical Policy Manual with a July 1, 2015, effective date, which contains ICD-9 codes, will continue to be available on indianamedicaid.com as an archived reference document after ICD-10 is implemented Providers are reminded that the archived manual will not include policy changes that occurred after July 1, 2015, and therefore, should not be considered an absolute resource for current policy The following slides contain the cross-walked ICD-10 codes for certain medical policies 14
15 Medical Policy Well child/epsdt visit - Z00.00 Tuberculosis assessment for Children Z20.1 Prenatal and preventive pediatric diagnosis codes that bypass cost avoidance see Code Sets page at indianamedicaid.com Presumptive Eligibility for Pregnant Women (PEPW) diagnosis codes see Code Sets page at indianamedicaid.com Hysterectomy procedures covered diagnoses see Code Sets page at indianamedicaid.com Sterilization procedures covered diagnoses see Code Sets page at indianamedicaid.com 15
16 Medical Policy Blood lead-exposure All children enrolled under the IHCP are required to receive a blood lead-screening test at 12 months and 24 months of age Children between 36 months and 72 months of age must receive blood lead screening if they have not been previously tested for lead poisoning Use ICD-10 code Z Contact with end (suspected) exposure to lead to identify a blood lead-exposure diagnosis 16
17 Medical Policy Dialysis specific diagnosis codes are required when billing for hemodialysis and peritoneal dialysis services rendered in a hospital outpatient setting, in an independent renal dialysis facilities called end-stage renal disease (ESRD) dialysis facilities, or in a patient s home The ICD-10 Dialysis Diagnosis Codes are available on the Code Sets page at indianamedicaid.com ICD-10 Birth Weight Diagnosis Codes see Code Sets page at indianamedicaid.com Code assignments from categories P05 Disorders of newborn related to slow fetal growth and fetal malnutrition and P07 Disorders of newborn related to short gestation and birth weight, not elsewhere classified should be based on recorded birth weight and estimated gestational age Providers are reminded that these codes should not be listed as the primary diagnosis 17
18 Medical Policy The IHCP follows the Centers for Medicare & Medicaid Services (CMS) determinations for hospital-acquired conditions (HACs), which will not be considered for payment if the diagnoses were not present on admission (POA). The IHCP also follows CMS determinations for diagnosis codes exempted from POA reporting. The ICD-10 Hospital Acquired Condition Diagnoses and the ICD-10 Diagnosis Codes Exempt from POA are available on the CMS website at cms.gov. 18
19 Medical Policy High-Risk Pregnancy Effective September 11, 2015, the IHCP revised the coverage policy for high-risk pregnancies The High-Risk Pregnancy policy was revised to include only the ICD-9 diagnosis code group V23 Supervision of High Risk Pregnancy, which includes codes V23.0 through V23.9 For dates of service (DOS) on or after October 1, 2015, providers will need to use diagnosis codes O09.00 through O09.93 to signify high-risk pregnancy As a reminder, high-risk pregnancy services MUST be rendered by physicians only 19
20 Medical Policy Medicaid Rehabilitation Option (MRO) The qualifying ICD-10 Mental Health and Addiction Diagnosis Codes can be found on the Code Sets page at indianamedicaid.com Please note that adults (ANSA Adult Needs and Strengths Assessment) and children or adolescents (CANS Child and Adolescent Needs and Strengths) have different qualifying diagnosis lists. A Yes under the applicable CANS/ANSA column indicates a qualifying MRO diagnosis for that category The Behavioral and Primary Healthcare Coordination (BPHC) The qualifying ICD-10 BPHC-Eligible Mental Health and Substance Abuse Diagnosis Codes can be found on the Code Sets page at indianamedicaid.com 20
21 21
22 Medical Policy Newborn Transferred for Observation When a newborn transfers to another hospital for observation, not for treatment for a specific illness, the receiving provider must enter the ICD-10 diagnosis code Z03.89 Encounter for observation for other suspected diseases and conditions ruled out Transportation and Waiver Providers Providers should bill ICD-10 diagnosis code R69 Illness, unspecified as the primary diagnosis code for claim submissions when the actual diagnosis is not known 22
23 Medical Policy Visual Evoked Potential (VEP) Current Procedural Terminology (CPT 1) code Visual evoked potential (VEP) testing central nervous system, checkerboard or flash when billed by an optometrist, provider specialty 180 See IHCP Bulletin BT for the appropriate ICD-10 diagnosis codes for VEP 23
24 Claims Processing Span-Dates Claims submitted with both ICD-9 and ICD-10 codes will deny Inpatient, inpatient crossover, and long term care Admission (From) date is prior to October 1, 2015, but the discharge (through) date is on or after October 1, 2015, use ONLY ICD-10 IHCP currently uses the From date for inpatient and inpatient crossover claims with the ICD-10 implementation, the IHCP will convert to using the Through date in alignment with Medicare 24
25 Claims Processing Span-Dates Claims submitted with both ICD-9 and ICD-10 codes will deny Outpatient, outpatient crossover, home health, medical, and medical crossovers Providers must split claims so that only dates of service before October 1, 2015, are billed with ICD-9 codes and dates of service on after October 1, 2015, are billed with ICD-10 codes This aligns with Medicare FQHC FQHC crossover claims from Medicare are processed as outpatient crossover claims. FQHC claims for members without Medicare are billed on the CMS Both follow the above guidelines 25
26 Claims Processing Span-Dates Supplier claims for durable medical equipment (DME) and medical supplies If the From date is before October 1, 2015, but the Through date is on or after October 1, 2015, use ONLY ICD-9 diagnosis and procedure codes on a single claim This aligns with Medicare 26
27 ICD-10 Resources For answers to common questions from providers about billing ICD-10 claims, see the CMS' ICD-10-CM/PCS Billing and Payment Frequently Asked Questions The booklet also includes links to additional resources about ICD-10. For information about ICD-10 implementation, visit roadto10.org at the CMS website. Diagnosis Code Set General Equivalence Mappings ICD-9 to ICD-10 and ICD-10 to ICD ICD-10-CM-and-GEMs.html For additional information, visit the ICD-10 Information page If you have questions about ICD-10 implementation, address them to the IHCP's ICD-10 Questions Mailbox at INXIX.ICD10Questions@HP.com 27
28 ICD-10 FAQ (frequently asked questions) The following Frequently Asked Questions documents are available at indianamedicaid.com using the ICD-10 link at the bottom of the page ICD-10 FAQs - Claims ICD-10 FAQs - Codes ICD-10 FAQs - Forms ICD-10 FAQs - Impact, assessment, benefits 28
29 APR-DRG
30 ICD-10 PCS Codes Effective October 1, 2015 Only used for inpatient claims Minimum/maximum characters = seven alphanumeric digits, no decimal 30
31 APR-DRG Grouper, Inpatient Hospital Rates The IHCP has selected the 3M All-Patient Refined (APR) Diagnosis-Related Group (DRG), version 30, as the grouper for ICD-10 DRG assignment DRGs are an inpatient classification scheme Payment methodology uses diagnoses, procedures, and certain patient demographics such as age, gender, and birth weight APR-DRGs assign a severity of illness (SOI) to each DRG and a risk of mortality (ROM) SOI used for IHCP ROM NOT used for IHCP 31
32 APR-DRG Grouper, Inpatient Hospital Rates APR and DRG weights are effective for inpatient stays with discharge dates on or after October 1, 2015 The current APR-DRG grouper, version 18, will remain in place for inpatient stays with discharge dates before October 1, 2015 Billing procedures for inpatient hospital services have not changed For information about the APR-DRG software, contact 3M at or visit 3M Health Information Systems on the 3M website at solutions.3m.com 32
33 Claims Processing and Rates Claims processing procedures have not changed; however, the actual rates will change DRG rate per case or level of care (LOC) Capital rate Medical education rate Outlier payment, if applicable Transfers 33
34 DRG/Level of Care Reimbursement IHCP will continue with the following reimbursement categories DRG system will reimburse a per-case rate according to diagnoses, procedures, age, gender, and discharge status Level of care (LOC) system for select cases on a per diem basis (psychiatric, burn, and rehabilitation cases) 34
35 Inpatient Stays of less than 24 hours Providers should continue to process inpatient stays of less than 24 hours in the same manner they do today For exceptions to the 24-hour policy, please follow the guidance published in IHCP Banner Pages BR and BR The IHCP policy regarding the expiration of a neonate within one day of birth has not changed with the introduction of the APR-DRG 35
36 Inpatient Stays less than 24 Hours Under the All-Patient (AP) DRG grouper, version 18, the following DRGs were exempt from the inpatient 24-hour policy because they were specific to one-day stays: DRG 637 Neonate, died w/in one day of birth, born here DRG 638 Neonate, died w/in one day of birth, not born here There is no direct crosswalk between these two AP-DRGs (637 and 638) and the new APR-DRG system A neonate that expires within one day of birth could be linked to any of the neonate APR-DRGs (all severity levels) Providers are advised to continue to submit inpatient claims for this scenario utilizing the administrative review process per the instructions in Chapter 10 of the IHCP Provider Manual, attaching documentation to support the inpatient neonate claim 36
37 DRG s Exempt from Transfer Reimbursement Policy As is current policy, DRGs relating to transfers of neonates less than five days old will continue to be exempt from the transfer reimbursement policies As such, APR-DRGs (all severity levels) are exempt from the transfer reimbursement policies 37
38 Claims Processing - X Codes ICD-10-PCS codes representing new technology (AKA X Codes) will be excluded from diagnosis-related group (DRG) pricing Noncovered for Indiana Health Coverage Programs 38
39 Updated Rates and Relative Weights New Rates and Weights On or after October 1, 2015 The DRG base rate will be $3, for acute care hospital services The DRG base rate for eligible children s hospitals will be $4, The threshold used to determine outlier payments will be updated to $51,425 Myers and Stauffer LC, (MSLC) the IHCP s hospital rate-setting contractor, will notify hospitals individually of their new global cost-to-charge ratio that is used to calculate outlier payments and their new medical education per diem rates Low-volume IHCP providers, new IHCP providers, and most out-of-state providers will receive the statewide median cost-to-charge ratio of
40 Updated Rates and Relative Weights The capital per diem rate remains unchanged at $64.50 A complete list of new relative weights and average lengths of stay (ALOS) associated with the new APR-DRG grouper, version 30, can be found in Provider Bulletin BT Please note that each DRG has four severity levels which allow for more detailed patient status information: 1 Minor 2 Moderate 3 Major 4 Extreme 40
41 Relative weights and ALOS - Sample 41
42 Level of Care (LOC) Rates LOC rates effective on or after October 1, 2015 Psychiatric $ Rehabilitation $ Burn 1 $2, Burn 2 $ DRG 757 will be paid at the psychiatric LOC rate unless billed with ICD-10 diagnosis codes F70-F79. Claims that group to DRG 757, when billed with diagnosis codes F70-F79, will pay using the DRG payment methodology, rather than the LOC per diem methodology Provider-specific per diem rates for providers classified as provider specialty 013 Medicaid Long-Term Acute Care (LTAC) Hospital will be communicated to qualifying providers individually by MSLC 42
43 Find Help
44 Helpful Tools Avenues of resolution IHCP website at indianamedicaid.com IHCP Provider Manual Customer Assistance Written Correspondence HP Provider Written Correspondence P. O. Box 7263 Indianapolis, IN Provider field consultant View a current territory map and contact information online at indianamedicaid.com 44
45 Q&A
Inpatient Hospital Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Inpatient Hospital Services LIBRARY REFERENCE NUMBER: PROMOD00035 PUBLISHED: NOVEMBER 30, 2017 POLICIES AND PROCEDURES AS OF SEPTEMBER 1, 2017
More informationCMS-1500 Billing and Reimbursement. HP Provider Relations/October 2013
CMS-1500 Billing and Reimbursement HP Provider Relations/October 2013 Agenda Common Denials for CMS-1500 CMS-1500 Claims Billing Types of CMS-1500 Claims Paper Claim Billing Fee Schedule Crossover Claims
More informationMental Health Services
Mental Health Services Fee-for-Service Indiana Health Coverage Programs DXC Technology October 2017 1 Agenda Reference Materials Provider Healthcare Portal Outpatient Mental Health Inpatient Mental Health
More informationICD-10 Transition Provider Roadshow. October 2012
ICD-10 Transition Provider Roadshow October 2012 About ICD-10 ICD-10 CM for diagnosis coding For use in all US healthcare settings Uses 3 to 7 digits instead of the 3 to 5 digits ICD-10-PCS for inpatient
More informationHospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services
Hospital Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1 Training Topics Provider Bulletins Outpatient Claim Billing Changes Explanation of Benefit Codes Web
More informationDistrict of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions
District of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions Version Date: July 20, 2017 Updates for October 1, 2017 Effective October 1, 2017 (the District s fiscal year
More informationTips for Completing the UB04 (CMS-1450) Claim Form
Tips for Completing the UB04 (CMS-1450) Claim Form As a Beacon facility partner, we value the services you provide and it is important to us that you are reimbursed for the work you do. To assure your
More informationDistrict of Columbia Medicaid Specialty Hospital Project Frequently Asked Questions
District of Columbia Medicaid Specialty Hospital Project Frequently Asked Questions Version Date: September 22, 2014 UPDATE: The District of Columbia Department of Health Care Finance (DHCF) is submitting
More informationMental Health Updates. Presented by EDS Provider Field Consultants
Mental Health Updates Presented by EDS Provider Field Consultants October 2007 Agenda Session Objectives Outpatient Mental Health Medicaid Rehabilitation Option (MRO) Somatic Treatment Assertive Community
More informationHome and Community- Based Services Waiver Program. HP Provider Relations/October 2014
Home and Community- Based Services Waiver Program HP Provider Relations/October 2014 Agenda Objectives Overview of the Home and Community- Based Services (HCBS) Waiver Program Member eligibility Billing
More informationTracks to Transportation
Insert photo here Tracks to Transportation Presented by EDS Provider Field Consultants OCTOBER 2007 Agenda Transportation Code Set Ambulance Transportation Non-Ambulance Transportation Commercial Ambulatory
More informationSubject: Updated UB-04 Paper Claim Form Requirements
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 0 2 J A N U A R Y 3 0, 2 0 0 7 To: All Providers Subject: Updated UB-04 Paper Claim Form Requirements Overview The following
More informationCarondelet Health Network APR DRG Information for Physicians September 2014
Carondelet Health Network APR DRG Information for Physicians September 2014 Introduction Changes in the reimbursement process for services rendered to AHCCCS patients will go into effect beginning on October
More informationDC Inpatient APR-DRG Payment for Acute Care Hospitals
DC Inpatient APR-DRG Payment for Acute Care Hospitals Provider Training 2014 Xerox Corporation. All rights reserved. Xerox and Xerox Design are trademarks of Xerox Corporation in the United States and/or
More informationIcd 10 code health maintenance
Icd 10 code health maintenance The Borg System is 100 % Icd 10 code health maintenance Codes. Z13 Encounter for screening for other diseases and disorders. Z13.0 Encounter for screening for diseases of
More informationLaboratory Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved.
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Laboratory Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 3 6 P U B L I S H E D : J U N E 2 9, 2 0 1 7 P O L I C I
More informationICD-10 Frequently Asked Questions - AdvantX
ICD-10 Frequently Asked Questions - AdvantX What Version of AdvantX is ICD-10 Compliant? Version 5.0.01 Where can I find ICD-10 Training Materials for AdvantX? 1. Visit our Client Portal (portal.sourcemed.net)
More informationThe Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
More informationTelemedicine and Telehealth Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Telemedicine and Telehealth Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 8 P U B L I S H E D : J A N U A R Y 1
More informationICD Codes health health health
1-10-2017 Encounter for screening for malignant neoplasm of cervix. 2016 2017 2018 Billable/Specific Code Female Dx POA Exempt. Z12.4 is a billable/specific ICD-10. ICD-10 is the 10th revision of the International
More informationA McKesson Perspective: ICD-10-CM/PCS
A McKesson Perspective: ICD-10-CM/PCS Its Far-Reaching Effect on the Healthcare Industry Executive Overview While many healthcare organizations are focused on qualifying for American Recovery & Reinvestment
More informationICD-10 Frequently Asked Questions - SurgiSource
ICD-10 Frequently Asked Questions - SurgiSource What Version of SurgiSource is ICD-10 Compliant? Version 6.0 Where can I find ICD-10 Training Materials for SurgiSource? 1. Visit our Client Portal (portal.sourcemed.net)
More informationICD-10 Frequently Asked Questions
ICD-10 Frequently Asked Questions September 2015 pulseinc.com + 1.800.444.0882 We care for your practice, as if it were our own. Acknowledgments Document Number: 01 Date: September 7, 2015 Pulse Systems
More informationAINPEC Anthem Blue Cross and Blue Shield first quarter provider updates 2016
AINPEC-0651-16 Anthem Blue Cross and Blue Shield first quarter provider updates 2016 Agenda Introductions Availity update Hoosier Healthwise updates - Franciscan Alliance changes effective April 1, 2016
More informationHome Health & HP Provider Relations
Home Health & Hospice HP Provider Relations October 2010 Agenda Session Objectives Home Health Benefit Coverage Billing Overhead Multiple Visits Most Common Denials Hospice Benefit Coverage Election/Revocation/Discharge
More informationSubject: 2007 Indiana Health Coverage Programs Provider Seminar
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 2 2 S E P T E M B E R 4, 2 0 0 7 To: All Providers Subject: 2007 Indiana Health Coverage Programs Provider Seminar Overview
More informationHCA APR-DRG and EAPG Rebasing Revised February 2017
HCA APR-DRG and EAPG Rebasing Revised February 2017 Inpatient and Outpatient Pricing Effective 11/01/2014 to Current Inpatient pricing From AP DRG to APR DRG HCA is using 3M Standard Weights Pricing goes
More informationMedical Practitioner Reimbursement
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Medical Practitioner Reimbursement LIBRARY REFERENCE NUMBER: PROMOD00016 PUBLISHED: FEBRUARY 28, 2017 POLICIES AND PROCEDURES AS OF APRIL 1,
More informationImportant Billing Guidelines
Important Billing Guidelines The guidelines contained herein are meant to assist GHP Family Participating Providers in billing appropriately for medically necessary services rendered to GHP Family Members.
More information3M Health Information Systems. The standard for yesterday, today and tomorrow: 3M All Patient Refined DRGs
3M Health Information Systems The standard for yesterday, today and tomorrow: 3M All Patient Refined DRGs From one patient to one population The 3M APR DRG Classification System set the standard from the
More informationINPATIENT HOSPITAL REIMBURSEMENT
HCRA CLAIMS PROCESSING Reimbursement: HCRA is not Medicaid; however, HCRA covered services are reimbursed at the hospital s outpatient or inpatient reimbursement rate allowed for Florida Medicaid. The
More informationMedicaid Fundamentals. John O Brien Senior Advisor SAMHSA
Medicaid Fundamentals John O Brien Senior Advisor SAMHSA Medicaid Fundamentals Provides medical benefits to groups of low-income people with no medical insurance or inadequate medical insurance. Federally
More informationJune 18, 2009 Page 1
Base Year Current LOC base rates calculated using: Wyoming Medicaid inpatient hospital claims data from July 1, 1994 through December 31, 1996 Most recently audited Medicare cost report with provider fiscal
More informationSubject: 2009 Indiana Health Coverage Programs Provider Seminar
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 930 A U G U S T 2 7, 2009 To: All Providers Subject: 2009 Indiana Health Coverage Programs Provider Seminar Overview The Office
More informationBilling Maryland Medicaid: Guidance for SBHCs
Billing Maryland Medicaid: Guidance for SBHCs An update for billers Maureen Regan, Office of Health Services Presentation Overview Today s presentation will cover: Need-to-know terms and acronyms Medicaid
More informationCoding and Payment Guide for Chiropractic Services. A comprehensive coding, billing, and reimbursement resource for chiropractic services
Coding and Payment Guide for Chiropractic Services A comprehensive coding, billing, and reimbursement resource for chiropractic services 2014 Contents Introduction...1 Coding Systems... 1 Claim Forms...
More informationMental Health and Addiction Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Mental Health and Addiction Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 3 9 P U B L I S H E D : A P R I L 1 8, 2
More informationOhio Hospital Association Finance Committee 2018 Hospital Inpatient Reimbursement Recommendations
Ohio Hospital Association Finance Committee 2018 Hospital Inpatient Reimbursement Recommendations Freddie L. Johnson, JD, MPA Chief Medical Services & Compliance Officer August 10, 2017 2018 Inpatient
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT AUGUST 30, 2016
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201648 AUGUST 30, 2016 2016 IHCP Annual Provider Seminar scheduled for October 18-20 in Indianapolis The Indiana Family and Social Administration (FSSA)
More informationPresented to you by The Cooperative of American Physicians, Inc.
ICD-10 Action Guide for Medical Practices PAGE 1 Presented to you by The Cooperative of American Physicians, Inc. Table of Contents Introduction... 3 What Is Changing and Why?... 4 What Are the Main Provisions
More informationProvider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Policy Number 2018F7002A Annual Approval Date 3/14/2018 Approved By Reimbursement Policy Oversight Committee
More informationIndiana Hospital Assessment Fee -- DRAFT
Indiana Hospital Assessment Fee -- DRAFT September 27, 2011 Inpatient Fee The initial Indiana Inpatient Hospital Fee applies to inpatient days from each hospital's most recent FYE as taken from the cost
More informationAll Indiana Health Coverage Programs Providers. Package C Claim Submission and Coverage Information
P R O V I D E R B U L L E T I N B T 2 0 0 0 0 6 J A N U A R Y 2 0, 2 0 0 0 To: Subject: All Indiana Health Coverage Programs Providers Package C Claim Submission and Coverage Information Overview The purpose
More informationINPATIENT/COMPREHENSIVE REHAB AUDIT DICTIONARY
Revised 11/04/2016 Audit # Location Audit Message Audit Description Audit Severity 784 DATE Audits are current as of 11/04/2016 The date of the last audit update Information 1 COUNTS Total Records Submitted
More informationIHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR MAY 22, 2018
IHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR201821 MAY 22, 2018 IHCP issues guidance for billing and rebilling inpatient rehabilitation encounters The Indiana Health Coverage Programs (IHCP) has
More informationICD-10 Frequently Asked Questions for Providers Q Updates
ICD-10 Frequently Asked Questions for Providers Q4 2012 Updates What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by
More informationPresented by: Gary Lucas, CPC, CPC-I, AHIMA Approved ICD-10-CM & PCS Trainer and Ambassador
Presented by: Gary Lucas, CPC, CPC-I, AHIMA Approved ICD-10-CM & PCS Trainer and Ambassador President, Discover Compliance Resources, Inc. Atlanta/Decatur, GA June 5, 2013 Alabama-Georgia Rural Health
More informationJurisdiction 1 Part B Updated ICD-10 Implementation Information. 1 of 7 10/1/12 8:44 AM
^ Back to Top Palmetto GBA CorporatePalmetto GBA Medicare Palmetto GBA Home / Jurisdiction 1 Part B / Browse by Topic / ICD-10 / Updated ICD-10 Implementation... Jurisdiction 1 Part B Updated ICD-10 Implementation
More informationJune 12, Dear Dr. McClellan:
June 12, 2006 Mark McClellan, MD, PhD Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1488-P PO Box 8011 Baltimore, Maryland 21244-1850 Dear
More informationRelease Notes for the 2010B Manual
Release Notes for the 2010B Manual Section Rationale Description Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths completed Date to NICU Cesarean Section Clinical
More informationDivision C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A
Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationPresented by: Sparkle Sparks, PT MPT HCS-D COS-C AHIMA Approved ICD-10 Coding Instructor OASIS Answers, Inc. Senior Associate Consultant
Presented by: Sparkle Sparks, PT MPT HCS-D COS-C AHIMA Approved ICD-10 Coding Instructor OASIS Answers, Inc. Senior Associate Consultant This educational presentation is provided by The preferred partner
More informationRequired Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) Care Healthcare and VNSNY CHOICE Transition
2018 Provider Manual VNSNY CHOICE Appendix V Claims CMS-1500 Form (Sample) UB-04 Form (Sample) Required Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) ICD-10 FAQ Care Healthcare
More informationHome Health, Hospice, and Nursing Facility. Indiana Health Coverage Programs DXC Technology October 2017
Home Health, Hospice, and Nursing Facility Indiana Health Coverage Programs DXC Technology October 2017 Agenda Billing Tips Home Health Hospice Nursing Facility Claim Form Update Helpful Tools Questions
More informationInappropriate Primary Diagnosis Codes Policy
Policy Number 2017R0122H Inappropriate Primary Diagnosis Codes Policy Annual Approval Date 11/8/2017 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission
More informationInpatient Hospital Rates Rebasing Report
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Inpatient Hospital
More informationChapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement
Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of
More informationCareFirst ICD-10 Claim Submission Guidelines
CareFirst ICD-10 Claim Submission Guidelines Introduction The U.S. Department of Health and Human (HHS) has released a HIPAA administration simplification mandate requiring all HIPAA entities to adopt
More informationChapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement
Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of
More informationTen Tips for ICD-10. September 17, Theresa Marshall, Sr. Director Compliance Data Experian Health
Ten Tips for ICD-10 September 17, 2015 Theresa Marshall, Sr. Director Compliance Data Experian Health Experian and the marks used herein are service marks or registered trademarks of Experian Information
More informationICD-10 Scenario Based Testing Analysis, Planning and Testing Driven by a Reference Implementation Model
A Health Data Consulting White Paper 1056 6th Ave S Edmonds, WA 98020-4035 206-478-8227 www.healthdataconsulting.com ICD-10 Scenario Based Testing Analysis, Planning and Testing Driven by a Reference Implementation
More informationAnatomy and Physiology: A Critical First Step
LET THE COUNT DOWN BEGIN Anatomy and Physiology: A Critical First Step Getting Medical Coders Ready for ICD-10-CM/PCS Authored by Clare Carvel, M.Ed., RHIA, CCS Education Consultant Barry Libman, Inc.
More informationOutpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
More informationBCBSTX Admission Type Definitions Grouper Version 33
Shared NPI between Acute Care and Specialty Provider numbers NPI is not shared between Acute Care and Specialty Provider numbers Residential Treatment Center, Eating Disorder Inpatient DRG 876, 880-887
More informationChapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups
Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
UnitedHealthcare Oxford Reimbursement Policy PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.19 T0 Effective Date: July 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE...
More informationHealthy Indiana Plan Reimbursement Manual
H P M a n a g e d C a r e U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Attention: This manual has not been archived, because the associated provider reference module is not yet complete.
More informationICD-10 Where Do We Go From Here? The Anticipated Impact on Reimbursement February 24, 2015
ICD-10 Where Do We Go From Here? The Anticipated Impact on Reimbursement February 24, 2015 Introductions Cortnie R. Simmons, MHA, RHIA, CDIP, CCS Managing Director of Education Services Brad Justus, Strategic
More informationWV Bureau for Medical Services & Molina Medicaid Solutions
WV Bureau for Medical Services & Molina Medicaid Solutions On January 1, 2014, Medicaid eligibility was expanded to qualified individuals ages 19 to 64 making 138% of the Federal Poverty Level. 112,464
More informationMedicaid Rehabilitation Option Provider Manual
H P P r o v i d e r R e l a t i o n s U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Medicaid Rehabilitation Option Provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R
More informationICD-10-CM/PCS Building Expert Trainers in Diagnostic and Procedure Coding. Information Provided by: AHIMA Academy for ICD-10-CM/PCS Trainers
ICD-10-CM/PCS 2011 Building Expert Trainers in Diagnostic and Procedure Coding Information Provided by: AHIMA Academy for ICD-10-CM/PCS Trainers www.ahima.org/icd10 About Version HIPAA 5010 To process
More informationRegulatory Compliance Risks. September 2009
Rehabilitation Regulatory Compliance Risks September 2009 1 Agenda - Rehabilitation Compliance Risks Understand the basic requirements for Inpatient Rehabilitation Facilities (IRFs) and Outpatient Rehabilitation
More informationNote: Telemedicine is not the use of the following. (1) Telephone transmitter for transtelephonic monitoring; or
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 8 0 2 J A N U A R Y, 8 2 0 0 8 To: All Providers Subject: Overview Effective April 1, 2007, telemedicine services are covered
More informationEnsuring a Successful Transition to ICD-10-CM and ICD-10-PCS for Post Acute Care Settings
Ensuring a Successful Transition to ICD-10-CM and ICD-10-PCS for Post Acute Care Settings August 9, 2012 Nelly Leon-Chisen, RHIA Director Coding and Classification American Hospital Association Recent
More informationRadiology Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved.
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Radiology Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 4 P U B L I S H E D : D E C E M B E R 1 2, 2 0 1 7 P O L
More informationHome Health Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Home Health Services L I B R A R Y R E F E R E N C E N U M B E R P R O M O D 0 0 0 3 2 P U B L I S H E D : N O V E M B E R 7, 2 0 1 7 P O L I
More informationHospital Payments and Quality Initiatives
Hospital Payments and Quality Initiatives December 2014 John McCarthy Ohio Medicaid Director Today s Overview How Ohio Medicaid pays hospitals - Prospective Payment Methods - Inpatient Hospital Payment
More informationFacility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By
Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE
More informationMedi-Pak Advantage: Reimbursement Methodology
Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses
More informationMedi-Cal APR-DRG Updates. Medi-Cal Updates. Agenda. Medi-Cal APR-DRG Updates Quality Assurance Fee (QAF) Program
Medi-Cal Updates Amber Ott California Hospital Association Agenda Medi-Cal APR-DRG Updates Quality Assurance Fee (QAF) Program Current QAF Law (SB239) Prop 52 Medicaid Managed Care Final Rules QAF 5 Development
More informationFrequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM
Frequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM Plan Year: July 2010 June 2011 Background The Harvard Pilgrim Independence Plan was developed in 2006 for the Commonwealth of Massachusetts
More informationIf you want to subscribe to the provider only listserv, please with subscribe as the subject line.
From: Sent: CMS ROCHI_Prov_Outreach Tuesday, March 06, 2012 1:48 PM Subject: CMS Medicare FFS Provider e News for Thu Mar 1 If you want to subscribe to the provider only listserv, please email: ROCHIFM@cms.hhs.gov
More informationICD-10: Preparation and Implementation Strategies Leah Killian-Smith
Transitioning from ICD 9 to 10, LNHA, RHIA Director of Corporate Accounts OBJECTIVES Know what ICD-10 is & why coding is changing Know differences between ICD-9 and ICD-10 Identify regulatory requirements
More informationNebraska pays for telepsychiatry + a separate transmission fee ($.08/minute).
Nebraska pays for telepsychiatry + a separate transmission fee ($.08/minute). Nebraska Telehealth Statutes 2014 Legislative Bill 1076 enacted in 2014 allows Medicaid payment for telehealth when patient
More informationICD 10 CM State of Transition
ICD 10 CM State of Transition Tricia A. Twombly, RN, BSN, HCS D, HCS C, COS C, CHCE, AHIMA ICD 10 Trainer, ICE Certified Credentialing Specialist, CEO Board of Medical Coding and Compliance, Senior Director
More informationTELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018
TELEMEDICINE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 114.28 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES
More informationChapter 6 Section 3. Hospital Reimbursement - TRICARE DRG-Based Payment System (Basis Of Payment)
Diagnostic Related Groups (DRGs) Chapter 6 Section 3 Hospital Reimbursement - TRICARE DRG-Based Payment System (Basis Of Payment) Issue Date: October 8, 1987 Authority: 32 CFR 199.14(a)(1) 1.0 APPLICABIITY
More informationSession 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices. Moderator/Presenter: Sabrina H.
Session 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices Moderator/Presenter: Sabrina H. Gibson, FSA, MAAA Presenters: Dawna Nibert Lawrence R. Smart, FSA, MAAA Society of Actuaries
More informationRFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS
The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,
More informationChapter VII. Health Data Warehouse
Broward County Health Plan Chapter VII Health Data Warehouse CHAPTER VII: THE HEALTH DATA WAREHOUSE Table of Contents INTRODUCTION... 3 ICD-9-CM to ICD-10-CM TRANSITION... 3 PREVENTION QUALITY INDICATORS...
More informationTroubleshooting Audio
Welcome Audio for this event is available via ReadyTalk Internet streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines
More informationI. Cost Finding and Cost Reporting
FLORIDA TITLE XIX INPATIENT HOSPITAL REIMBURSEMENT PLAN VERSION XLIV EFFECTIVE DATE July 1, 2017 I. Cost Finding and Cost Reporting A. Each hospital participating in the Florida Medicaid program shall
More informationTCS FAQ s. How will the implementation of national standard code sets reduce burden on the health care industry?
TCS FAQ s What is a code set? Under HIPAA, a code set is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.
More informationSame Day/Same Service Policy, Professional
Same Day/Same Service Policy, Professional Policy Number 2018R0002D Annual Approval Date 7/11/2018 Approved By REIMBURSEMENT POLICY CMS-1500 Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT
More informationChapter 14: Long Term Care
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S P R O V I D E R M A N U A L Chapter 14: Long Term Care Library Reference Number: PRPR10004 14-1 Chapter 14 Indiana Health Coverage Programs Provider
More informationBanner Message for the 01/30/06 ER&S and the 02/03/06 R&S Reports
Banner Message for the 01/30/06 ER&S and the 02/03/06 R&S Reports This file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and
More information2018 Biliary Reimbursement Coding Fact Sheet
The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,
More informationAbsolute Total Care. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Description 2016
Absolute Total Care Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Description 2016 TABLE OF CONTENTS INTRODUCTION: --------------------------------------------------------------
More informationProcedural andpr Diagnostic Coding. Copyright 2012 Delmar, Cengage Learning. All rights reserved.
Procedural andpr Diagnostic Coding What is Coding? Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors Accurate coding maximizes reimbursement
More information