FEBRUARY 2016 EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER - - PowerPoint PPT Presentation

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FEBRUARY 2016 EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER - - PowerPoint PPT Presentation

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FLORIDA MEDICAID UPDATE FEBRUARY 2016 EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH REIMBURSEMENT OF HOSPITAL INPATIENT CLAIMS AND EXPRESS ENROLLMENT The individuals Medicaid eligibility span will begin on the first

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FLORIDA MEDICAID UPDATE FEBRUARY 2016

EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH

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REIMBURSEMENT OF HOSPITAL INPATIENT CLAIMS AND EXPRESS ENROLLMENT

 The individual’s Medicaid eligibility span will begin on the first

day of the same month (or the first day of an earlier month, if the determination is retroactive).

 A hospital admission occurring after Medicaid eligibility begins

but before MMA health plan enrollment occurs will be covered under fee-for-service. Providers must request a prior authorization from eQHealth Solutions for coverage of fee-for- service inpatient hospital stays.

 A hospital admission occurring after Medicaid eligibility begins

and health plan enrollment occurs will be covered by the enrollee’s health plan.

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EXAMPLE

 DCF determines a patient Medicaid eligible on 1/7/16, retroactive to

1/1/16.

 The recipient is enrolled in a MMA health plan effective 1/7/16.  If the recipient was admitted to the hospital between 1/1/16 and

1/6/16, the entire hospital stay will be covered under fee-for-service. The hospital must request a prior authorization from eQHealth Solutions.

 If the recipient was admitted to the hospital on 1/7/16 or later, the

MMA health plan will cover the hospital stay. http://ahca.myflorida.com/medicaid/statewide_mc/express_enroll.shtml

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UPDATES TO THE VAGUS NERVE STIMULATOR

The following procedure codes must be utilized: 64568 (Implantation of Cranial Nerve Neurostimulator Electrodes and Generator) and 61885 (Insertion or Replacement of Brain Neurostimulator Generator or Receiver.) These procedure codes became effective July 1, 2013 and were communicated to Medicaid hospitals providers at that time.

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UPDATES TO CMS FAQ

 Are physicians who practice in hospital-based

ambulatory clinics eligible to receive Medicare or Medicaid electronic health record (EHR) incentive payments?

 National Provider Identifier (NPI)  last 5 digits of your Tax Identification Number (TIN)  Registration & Attestation website

 What steps do eligible hospitals need to take to meet

the specialized registry objective? Is it different from EPs?

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X-12 834R BENEFIT ENROLLMENT & MAINTENANCE IMPLEMENTATION

For example, the following new X12 834R files are posted to reflect the May 2016, X12 820 capitation payments:

 The X12 834R file will include current enrollments reflective of a May 2016,

payment on the X12 820.

 The X12 834R1 file will include enrollments reflective of a April 2016, the

previous month payment/adjustments on the X12 820.

 The X12 834R2 file will include enrollments reflective of a March 2016, two

months previous payment/adjustments on the X12 820.

 The X12 834R3 file will include enrollments reflective of a February 2016,

three months previous payment/adjustments on the X12 820.

 It is anticipated that the first X12 834R files will be available for May 2016,

X12 820 capitation payments.

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http://fhin.net/docs/NewsBytes.pdf In this edition of News Bytes you will find information on:

 Electronic Health Record

(EHR) Incentive Program general requirements, Meaningful Use applications, and Public Health Reporting

 The progress of the Florida

Health Information Exchange (Florida HIE) Event Notification Service (ENS), and Patient Look-Up (PLU) service

 Using Direct Messaging to

help meet Meaningful Use

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CMS EXTENDS THE ATTESTATION DEADLINE FOR THE EHR INCENTIVE PROGRAMS TO MARCH 11, 2016

To attest to the EHR Incentive Programs in 2015:

Eligible Professionals may select an EHR reporting period of any continuous 90 days from January 1, 2015 (the start of the 2015 calendar year) through December 31, 2015.

Eligible Hospitals/CAHs may select an EHR reporting period of any continuous 90 days from October 1, 2014 (the start of the federal fiscal year) through December 31, 2015. Attestation Resources For assistance with attestation, please review the following CMS resources:

Preparing to Participate in the EHR Incentive Programs Fact Sheet

Attestation Worksheet and User Guide for Eligible Professionals

Attestation Worksheet and User Guide for Eligible Hospitals and CAHs

Broadband Access Exclusions Tip Sheet

Health Information Exchange Fact Sheet

Public Health Reporting in 2015 for Eligible Professionals

Public Health Reporting in 2015 for Eligible Hospitals/CAHs

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PROPOSED RULE

Rule 59G-4.015, Emergency Transportation Services The workshop is scheduled for March 3, 2016 from 1:30 p.m. to 2:30 p.m. ET at the:

 Agency for Health Care Administration

2727 Mahan Drive Building 3, Conference Room A Tallahassee, FL 32308

 There will not be a phone call-in number available.

Rule 59G-4.330, Non-Emergency Transportation Services The workshop is scheduled for March 3, 2016 from 2:30 p.m. to 3:30 p.m. ET at the:

 Agency for Health Care Administration

2727 Mahan Drive Building 3, Conference Room A Tallahassee, FL 32308

 There will not be a phone call-in number available.

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WHERE TO GET DRAFT DOCUMENTS, MEDICAID FORMS & HEARING DRAFTS?

http://ahca.myflorida.com/Medicaid/review/index.shtml

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FLORIDAHEALTHFINDER.GOV WEBINAR

February 26, 2016 at 10:00 a.m. ET

https://attendee.gotowebinar.com/register/34232132776286 22849 In order to access the audio portion of the webinar: Dial (Toll-Free): 1-877-309-2074 Attendee Access Code: 501-963-021

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EVENT NOTIFICATION SERVICE (ENS) WEBINAR

February 25, 2016 2:00 PM EST at: https://attendee.gotowebinar.com/register/6729546 996687095042

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PRESTIGE HEALTH CHOICE

February 12, 2016:

 Prestige Requires the Ordering, Referring, or Prescribing

Practitioner’s Name and NPI on Claims for Specific Services

 Click here for full letter

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PRESTIGE HEALTH CHOICE

February 12 Notification Continued

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PRESTIGE HEALTH CHOICE

Emdeon is now “Change Healthcare”

Click here for full letter

 Change Healthcare has not closed the existing Emdeon website. All

existing Emdeon bookmarks will continue to work.

 The "Login" button on the new (Change Healthcare) site will redirect

you to legacy (Emdeon) sites and product lists.

 Contact Change Healthcare (Emdeon) at 1-877-363-3666 or visit

www.changehealthcare.com and select “Resources” for:

  • Enrollment
  • Product support
  • Payer lists
  • EFT/e-payment
  • Payer ERA
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LIVE WEBINAR: February 24, 2016 12:00 pm – 1:15 pm EST Follow these instructions to register:

  • 1. Go to https://medconcert.community360.net/activity/3917287/detail.aspx

  • 2. Complete the registration

  • 3. Create a username and password

  • 4. Receive email confirmation

PRESTIGE HEALTH CHOICE

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STAYWELL/WELLCARE 02/17/2016 CLICK HERE FOR FULL NEWSLETTER

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EFFECTIVE JANUARY 2016: PRIOR AUTHORIZATION LIST CLICK HERE FOR FULL LIST FROM SUNSHINE HEALTH CLICK HERE FOR FULL LIST OF FULL MEDICAID AND CHILD WELFARE LIST OF DRUGS REQUIRING PRIOR AUTHORIZATION

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TELEHEALTH UPDATE

February 8th / February 17th publications The House Health Care Appropriations Subcommittee unanimously passed the measures (HB 7087 and HB 1175)

http://health.wusf.usf.edu/term/telemedicine#stream/0 http://floridapolitics.com/archives/202021-teleheath-bill-advances-in-florida-house-committee

Click here to read the full Bill Text

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FLORIDA EXPANDS TELEMEDICINE CONTROLLED SUBSTANCE PRESCRIBING

“This change has enormous potential to benefit patients in the Sunshine State, promoting access to mental health services and receiving the full scope of psychiatric treatment. Providers of telemedicine-based services, as well as providers of psychiatric services, should take this opportunity to explore the possibilities of offering care via telemedicine for psychiatric disorders.”

(4) Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. This provision does not preclude physicians or physician assistants from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed pursuant to Chapter 395, F.S.

Florida’s approach is consistent with new remote prescribing rules among a growing number of states (e.g., Delaware, New Hampshire) that are electing to defer to the physician’s independent medical judgment and prevailing standard of care, allowing controlled substances to be prescribed via telemedicine. This differs from the approach

  • f imposing specific telemedicine practice standards that notably differ from in-person

medical encounters. http://www.jdsupra.com/legalnews/florida-expands-telemedicine-controlled-90941/

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WEBINAR INFORMATION

HomeTown Health Florida Medicaid Information: http://hthu.net/flex-grant/florida-medicaid-webinars/