Alaska Medical Assistance Newsletter

Transcription

1 Alaska Medical Assistance Newsletter April 2011 Location Affiliated Computer Services, Inc S. Bragaw St., Suite 200 Anchorage, AK Web Address Phone Numbers (toll-free in Alaska) Fraud and Abuse Hotline or Recipient Services (toll-free in Alaska) Provider Inquiry (toll-free in Alaska) Fax Numbers PA PA: Travel, MRI, PI, and Mental Health or SUR EPS Finance Training Attachments or Enrollment Inside: Upcoming Holidays...1 Additional Providers Subject to NCCI Editing...1 Provider Training is Coming to Dillingham, Valdez, Kenai...1 FQHC and RHC: New Enrollment and Reporting Requirements...2 Tribal Health Clinics: New Enrollment and Reporting Requirements...2 Provider Appeals Process for Medicaid NCCI Edits...2 Pharmacy Program Changes...3 Interpretation Services: Federal Requirements and Provider Responsibilities...3 New Home and Community-Based Services (HCBS) Rate Regulations...3 Personal Care Assistants Enrollment Requirement...4 Alaska Medicaid Vaccine Coverage List 2011 Now Available...4 Payment Error Rate Measurement...4 Alaska Medicaid Electronic Health Record Incentive Payment Program...4 Updated Ak Medicaid Forms Available Online...4 Online Enrollment Available for New Providers...5 Ask Medicaid...5 Upcoming Holidays State of Alaska and ACS offices will be closed on Monday, May 30, 2011 in observance of Memorial Day. Additional Providers Subject to NCCI Editing Effective for services rendered on or after April 1, 2011, all Nurse Practitioner, Nurse Midwife, Occupational and Physical Therapist and Assistant, Speech Language Pathologist and Assistant, and Audiologist claims submitted to Alaska Medicaid must comply with National Correct Coding Initiative (NCCI) methodologies and will be subject to NCCI edits. This is required for Alaska Medicaid s implementation of the National Correct Coding Initiative (NCCI). The Patient Protection and Affordable Care Act (H.R. 3590) established NCCI edits which consist of both procedure-to-procedure edits and Medically Unlikely Edits (MUE) unit of service edits. Additional information regarding NCCI can be found at then select Provider/NCCI. If you have questions, please call ACS Provider Inquiry Unit at or (toll-free in Alaska). Provider Training is Coming to Dillingham, Valdez, Kenai ACS will offer provider training in Dillingham April 26 through April 28, In May, training is schedule for Valdez, May 3 through May 5, 2011, and Kenai, May 17 through May 19, Training sessions will cover introductory-level topics such as Recipient Eligibility and Prior Authorization to more in-depth training on tribal specific policies and procedures as well as site specific information. You may view the complete schedule at then select Training/Schedule. Other Training Offered in April and May Teleconference/WebEx training will also be offered April 5 through April 7, and May 3 through May 5, Please visit our website for more detailed information on the classes being offered and schedule of training topics. To register for these training opportunities, please go to Under the Training tab, select Online Registration, or you may fax the registration form to You will receive a confirmation notice that you are registered for class. If you have questions or require additional information, please contact the ACS Provider Training Department at anctraining@acs-inc.com, in Anchorage, or , in-state toll free Xerox Corporation and Affiliated Computer Services Inc. All Rights Reserved. Page 1 of 5

2 FQHC and RHC: New Enrollment and Reporting Requirements Effective for services rendered on or after May 1, 2011, CMS claim forms submitted to Alaska Medicaid must contain the rendering provider s NPI. As a result, all rendering providers at your Federally Qualified Health Center or Rural Health Clinic not currently enrolled with Alaska Medicaid must complete an individual provider enrollment application immediately and become individually enrolled with Alaska Medicaid. Rendering providers who must enroll include: physicians advanced nurse practitioners/nurse midwives physician assistants physical therapists and assistants speech-language pathologists and assistants occupational therapists and assistants audiologists optometrists opticians podiatrists chiropractors dietitians social workers psychologists For rendering providers already enrolled with Alaska Medicaid, please ensure that the rendering provider's individual enrollment is correctly associated with your clinic's facility enrollment. Enrollment information and forms are For complete instructions on filling out the CMS-1500 using the rendering provider s NPI please visit the ACS website at then select Providers/Updates From the Updates page, select the 03/30/11 updated document entitled "Federally Qualified Health Centers and Rural Health Clinics: New Enrollment and Reporting Requirements for Rendering Providers." Please ensure that this information is shared with all appropriate staff at your location. If you have questions, please call ACS' Provider Inquiry Unit at (907) or (800) (toll-free in Alaska). Tribal Health Clinics: New Enrollment and Reporting Requirements Effective for services rendered on or after May 1, 2011, CMS claim forms submitted to Alaska Medicaid must contain the rendering provider s NPI. As a result, all rendering providers at your tribal health clinic not currently enrolled with Alaska Medicaid must complete an individual provider enrollment application immediately and become individually enrolled with Alaska Medicaid. Rendering providers who must enroll include physicians physician assistants advanced nurse practitioners nurse midwives physical therapists and assistants speech-language pathologists and assistants occupational therapists and assistants audiologists optometrists podiatrists For rendering providers already enrolled with Alaska Medicaid, please ensure that the rendering provider's individual enrollment is correctly associated with your clinic's facility enrollment. Enrollment information and forms are For complete instructions on filling out the CMS-1500 using the rendering provider s NPI please visit the ACS website at then select Providers/Updates From the Updates page, select the 03/30/11 updated document entitled "Federally Qualified Health Centers and Rural Health Clinics: New Enrollment and Reporting Requirements for Rendering Providers." Please ensure that this information is shared with all appropriate staff at your location. If you have questions, please call ACS' Provider Inquiry Unit at (907) or (800) (toll-free in Alaska). Provider Appeals Process for Medicaid NCCI Edits National Correct Coding Initiative (NCCI) editing methodologies developed by the Centers for Medicare and Medicaid Services (CMS) are used by Alaska Medicaid to promote appropriate coding methodologies and to control improper coding that could lead to payment errors. NCCI Edits consist of two types: NCCI procedure-to-procedure edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. These edits will be applied to claims submitted by practitioners, ambulatory surgical centers, and outpatient services. Medically Unlikely Edits (MUE), Units-of-Service (UOS) edits, that define for each HCPCS/CPT code the number of units of service beyond which the reported number of units of service is unlikely to be correct. There are three lists of procedure codes and units that differ by the type of service. One list is for all DME services, one for practitioner and ambulatory surgical centers, and one for outpatient services. Complete lists of edits and coding guidelines can be found on the CMS website at April Xerox Corporation and Affiliated Computer Services Inc. All Rights Reserved. Page 2 of 5

3 Each NCCI procedure-to-procedure edit and each MUE units of service edit has a Correspondence Language Example Identification Number (CLEID). This number is used to obtain rationale for these edits and is used when corresponding about the edits. The CLEID identifies information in the Correspondence Language Manual, which can be found at D.asp. Both NCCI edits are set to deny and require providers to submit a first level appeal to ACS for reimbursement. Providers may appeal individual claim denials to ACS for Medicaid NCCI edits. Providers can submit an appeal using the Provider Appeals form located on the ACS website at: First level appeals must be filed within 180 days of the adverse decision to meet the appeals timely filing regulation, 7 AAC Instructions for submitting NCCI First Level Appeals: A NCCI First Level Appeal must include Appeals form completed and filled out correctly. A clean claim that can be processed without obtaining additional information from the provider of the service or from a third party. A copy of the claim denial (RA). Medical records/supporting documentation is required for ACS review of NCCI edits. First level appeals for NCCI edits must be mailed to: Affiliated Computer Services, Inc. (ACS) Attn: Appeals P.O. Box Anchorage, AK ACS adjudicates appeals based on federal and state regulations. Instructions for submitting NCCI Second Level Appeals: If the decision is upheld providers have the right to file a second level appeal. A second level appeal must be filed by the provider within 60 days of the first level appeal decision. Providers must submit the same documentation listed above and include a copy of the first level appeal determination. Second level appeals should be submitted to: Dept. of Health and Social Services Division of Health Care Services Attn: Claims Appeal Section 4501 Business Park Boulevard, Suite 24 Anchorage, AK Providers are required to follow both federal and State of Alaska Medicaid guidelines when billing. The recipient cannot be billed for any service that is denied and upheld either on a first or second level appeal. Providers may also contact the fiscal agent's Provider Appeals staff at Option 1, 5 (in-state, toll free) or option 8 (in Anchorage or outside Alaska) with questions about this policy and/or related claims processing efforts. Pharmacy Program Changes On or after April 27, 2011 the following changes will be implemented in the pharmacy point-of-sale system. Please visit the prior authorization website, for a detailed explanation of each change. The following products will require prior authorization Lidoderm Patches: Prior authorization will be required for all recipients. Pradaxa (75mg and 150mg): Prior authorization will be required for all recipients. Makena: Prior authorization will be required for all recipients. Interpretation Services: Federal Requirements and Provider Responsibilities Title VI of the Civil Rights Act of 1964, and federal regulations implementing Title VI prohibit exclusion of individuals on the grounds of race, color, or national origin from participation in programs that receive federal funding. As recipients of federal funding through Medicaid payments which are, in part, federally funded, enrolled providers may not employ practices that have a discriminatory impact on individuals. Medicaid-enrolled providers are obligated to provide access to health care services, including language interpreting services, when needed, for patients who have Limited English Proficiency (LEP). The U.S. Department of Health and Human Services has published a document that includes a four-factor analysis that guides providers through the process of determining the extent of their obligation to offer LEP services, and development of a plan to meet the needs of the LEP population. This document, "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons", is available in Volume 68, Number 153 of the Federal Register, published Friday, August 8, 2003, and then select Federal Register/2003/August/Friday August 8/Health and Human Services Department/Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. April Xerox Corporation and Affiliated Computer Services Inc. All Rights Reserved. Page 3 of 5

4 New Home and Community-Based Services (HCBS) Rate Regulations On January 24, 2011, the Department of Health and Social Services adopted new regulations that revised rate-setting methodologies for Medicaid Home and Community-Based Waiver Services, effective March 1, The Department has provided several resources to assist waiver providers in maintaining compliance under the new regulations, including Personal Care Attendant and Waiver Service Rates, Specialized Medical Equipment Fee Schedule 2011, and training materials for Assisted Living Providers and Home & Community Based Agency Providers. To view these resources please visit then select Providers/HCBC Waivers. Personal Care Assistants Enrollment Requirement In accordance with 7 AAC , all individuals employed as personal care assistants are now required to enroll as individual providers. This requirement applies to both consumer-directed and agency-based personal care assistants. Prior to the adoption of 7 AAC , only the PCA agencies were required to enroll. Each individual personal care assistant enrolling in Alaska Medicaid must supply a copy of a completed W-9 or a copy of their social security card, current First Aid Certificate, and a signature page signed by both the agency and the individual personal care assistant. Photocopies or faxed signature pages cannot be accepted. Questions regarding the enrollment process may be directed to Lyla Crane, Provider Enrollment Supervisor, at or lyla.crane@acs-inc.com. Alaska Medicaid Vaccine Coverage List 2011 Now Available A complete list of approved vaccines covered by Alaska Medicaid for 2011 is now and select Providers/Updates. The list includes all approved vaccines, those recipients eligible for vaccine administration, and a breakout of reimbursement eligibility for vaccination and/or administration. Payment Error Rate Measurement In compliance with the Improper Payments Information Act of 2002, the Centers for Medicare and Medicaid Services (CMS) implemented a national Payment Error Rate Measurement (PERM) program to measure improper payments in the Medicaid program and the State Children's Health Insurance Program (SCHIP) in each state. Alaska's second PERM review has started; it focuses on Federal Fiscal Year 2011 (October 1, 2010 through September 30, 2011). Providers with claims selected, will be required to furnish the records requested within 75 days from the date of the request. Providers are urged to respond to these requests promptly upon receiving the request letter. Provider cooperation is critical in this CMS project. Lack of response to requests and/or insufficient documentation will be considered a payment error. This will result in a payback by the provider and a monetary penalty for Alaska Medicaid. Providers are encouraged to access the CMS website and click the Providers link on the left side of the page for specific details, sample request letters, and updates: The State of Alaska, Program Integrity Unit has requested a person in each provider office be designated as the PERM contact. Please the designee's contact information; name, title, phone, fax, address, and address, to Heidi Barnes at Heidi.Barnes@alaska.gov or fax attention: Heidi Barnes at Alaska Medicaid Electronic Health Record Incentive Payment Program As the health care landscape continues to modernize, recent legislation was passed to encourage the adoption of Electronic Health Record (EHR) technology in documenting patient care. To streamline the process in applying for the incentive and provide support resources to Medicaid providers, the Department of Health and Social Services has established the Alaska Medical Assistance program State Level Registry (SLR). The SLR web portal is a centralized "one-stop" launching pad of available tools for Medicaid providers to manage their EHR Incentive information. For more information about the Alaska Medicaid EHR Incentive Payment Program and the SLR please visit Updated Alaska Medicaid Forms Available Online The Alaska Medicaid website is the perfect tool to ensure your facility is using the most up-to-date forms when billing for services. Please visit and select Providers/Forms to download copies for your office. April Xerox Corporation and Affiliated Computer Services Inc. All Rights Reserved. Page 4 of 5

5 Online Enrollment Now Available for New Providers Becoming a Medicaid provider is now faster and easier. Providers now enroll online in the Alaska Medical Assistance program using the Provider Enrollment Portal (PEP). You are considered a new provider if: You have never been enrolled in the program. You are enrolling with a different Tax ID or Social Security Number. You are enrolling as a different provider type. If there are extenuating circumstances that prevent a provider from enrolling via the new Provider Enrollment Portal, they may submit a hardship request to Lyla Crane by phone at or by at: lyla.crane@acs-inc.com. For more information, download the PEP Online Provider Enrollment Overview PDF here: _Online_Provider_Enrollment_Overview.pdf. Computer-Based Training (CBT) is also /PEP101/, or you can go directly to PEP ( to get started. For information regarding individual Personal Care Assistant enrollments please contact your Personal Care Agency. You are Invited To Rochester Optical s 8 th Annual Open House On Thursday July 21, 2011, at 2:00 p.m., immediately following ACS scheduled Vision Services training, Rochester Optical, the Alaska Medical Assistance eyewear contractor, will host their 8 th annual Open House for Ophthalmologists, Optometrists, and Opticians who provide vision care services to Alaska Medicaid and Denali KidCare recipients. Experienced representatives from Rochester Optical will present their current product line and services and discuss ordering procedures. They will also be available to meet with providers one-on-one to discuss current issues and answer questions. Please join us at ACS: Third Floor Training Room 1835 S. Bragaw Street, Anchorage, Alaska Your reply is appreciated but not required for the Open House. If you will be joining us, you may contact Mary Hansen, the Alaska Medical Assistance Vision Services Program Manager, by at mary.hansen@alaska.gov, or by telephone, (907) We also invite you to attend the ACS Vision Services Training that will be held immediately preceding Rochester Optical s Open House. Knowledgeable ACS trainers will provide guidance on Alaska Medical Assistance program regulations and will discuss billing procedures and concerns, prior authorization procedures, and other topics of interest to vision care providers. To register for the ACS Vision Services training, please visit the ACS Website at and select Training, then Online Registration. You may also contact the ACS Provider Training Department at (907) or (800) (toll-free in Alaska). We look forward to seeing you on July 21st! Ask Medicaid Q: As summer approaches, my facility is considering adding a temporary, licensed provider to handle the influx of visitors and seasonal workers who wish to be seen in our office. Must this temporary employee enroll in Alaska Medicaid to receive reimbursement for services provided? A: Yes, according to 7 AAC (c) any provider who is practicing under a temporary or locum tenens (meaning placeholder ) permit available through the Alaska Department of Commerce Division of Corporations, Business, and Professional Licensing must enroll in Alaska Medicaid and submit claims using their National Provider Identifier (NPI) to be eligible for reimbursement. Q: My clinic sees Medicaid patients on weekends and at night, is there a way to verify their eligibility during nonbusiness hours? A: Yes, ACS s automated Eligibility Verification System (EVS) is available 24 hours, 7 days a week. EVS can provide your patient s month of eligibility, Medicaid ID number, and any third-party liability such as insurance. You will need the recipient s Social Security Number to verify eligibility. Q: Medicaid recipients seen in our office often need prior authorization to travel to and from their medical appointments. Are there expanded hours we can reach Medicaid in order to authorize their travel? A: The ACS Prior Authorization Unit can be reached by telephone Monday-Saturday from 8:00 am to 5:00 pm and Sunday from 12:00 pm to 4:00 pm. They can be reached locally in Anchorage at (907) (option 5) and tollfree in Alaska at (800) (option 1, 2). All authorization for travel and accommodations can be made during these times. April Xerox Corporation and Affiliated Computer Services Inc. All Rights Reserved. Page 5 of 5