FLORIDA UPDATES APRIL 2016 EVELYN LEADBETTER, MPA NETWORK SERVICES - - PowerPoint PPT Presentation

FLORIDA UPDATES APRIL 2016

EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH

March Monthly Actions

4 final orders to revoke an existing license 6 final orders to deny a license renewal 1 that resulted in the provider surrendering their license Some of these providers were enrolled in the Medicaid program and AHCA has terminated or is in the process of terminating their participation in the program. In addition, AHCA terminated eight providers from participation in the Medicaid program, prohibiting the providers from being paid for claims to the Medicaid program for furnishing, supervising a person who is furnishing,

• r causing a person to furnish goods or services.

UPDATE: FEE-FOR-SERVICE REQUEST FOR EXCEPTIONAL CLAIMS PROCESSING AND EXCEPTIONAL CLAIMS MAILING ADDRESS

Provider Type Mailing Address Instructions In-state Exceptional Claims Processing P.O. Box 7080 Tallahassee, FL 32314-7080 Each exceptional claim request submitted must include an individual completed “Request for Exceptional Claims Processing” form. This Form can be found by clicking the following link: Request For Exceptional Claims Processing Form Out-of-State

• St. Petersburg Field

Office 525 Mirror Lake Dr. N, Suite 510

• St. Petersburg, FL

33701-3219 Each exceptional claim request submitted must include an individual letter on the provider’s letterhead, explaining the request for exceptional handling.

EHR INCENTIVE PROGRAMS IN 2016: ALTERNATE EXCLUSIONS

Click here for the full Fact Sheet

THURSDAY, MAY 12, 2016: 2:00-3:00 PM EASTERN Conference Call Only PARTICIPANT DIAL-IN NUMBER: 800 837-1935 CONFERENCE ID #: 77707137 Understanding the IMPACT Act-Patient and Family Focused for Informed Decision Making

Hospitals that do not successfully participate in the Hospital IQR Program and do not submit the required quality data will be subject to a one-fourth reduction of the market basket update. Also, the law requires that any hospital that is not a meaningful EHR user will be subject to a three-fourths reduction of the market basket update in FY 2017. CMS projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $539 million in FY 2017.

Hospital Inpatient Prospective Payment System (IPPS)

Wednesday, May 4

th 3:00pm-4:30pm Eastern

Register here

Agenda: *PQRS and Value Modifier: Incentives and adjustments for CY 2018 *2016 PQRS reporting criteria for group practices reporting via the GPRO, including the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS survey *How to obtain an Enterprise Identity Management (EIDM) account *How to register for the PQRS GPRO in the PV-PQRS Registration System *Where to call for help and resources Target Audience: Physicians, Medicare individual eligible professionals and group practices, therapists, medical group practices, practice managers, medical and specialty societies, payers, and insurers.

Register for the 2016 PQRS Group Practice Reporting Option Call

EHR Incentive hardship: July 1, 2016

CMS posted new, streamlined hardship exception application forms that reduce the amount of information that eligible professionals, eligible hospitals, and critical access hospitals must submit to apply for an exception. The new applications and instructions for providers seeking a hardship exception are available here.

HIPAA Requirements

http://www.healthit.gov/providers-professionals/security-risk-assessment

View Volume 35 by clicking here

GOINGDIGITAL NEWS BYTES: VOLUME 35

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

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

FLORIDAHEALTHFINDER.GOV WEBINAR

Friday, April 29, 2016 at 10:00 a.m. ET https://attendee.gotowebinar.com/register/1 920106116988933635 In order to access the audio portion of the webinar: Dial (Toll-Free) 1-877-309-2071 Attendee Access Code: 611-183-380

NOTICE REGARDING MEDICAID PROVIDER ON-SITE ACTIVITIES

 “409.913 Oversight of the integrity of the Medicaid program.—The agency shall

• perate a program to oversee the activities of Florida Medicaid recipients, and

providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of recipients occur to the minimum extent possible, and to recover

• verpayments and impose sanctions as appropriate…

 (2) The agency shall conduct, or cause to be conducted by contract or otherwise,

reviews, investigations, analyses, audits, or any combination thereof, to determine possible fraud, abuse, overpayment, or recipient neglect in the Medicaid program and shall report the findings of any overpayments in audit reports as appropriate.”

 (15) The agency shall seek a remedy provided by law, including, but not limited to,

any remedy provided in subsections (13) and (16) and s. 812.035, if:



(a) The provider’s license has not been renewed, or has been revoked, suspended, or terminated, for cause, by the licensing agency of any state;



(b) The provider has failed to make available or has refused access to Medicaid-related records to an auditor, investigator, or other authorized employee or agent of the agency, the Attorney General, a state attorney, or the Federal Government;



(c) The provider has not furnished or has failed to make available such Medicaid-related records as the agency has found necessary to determine whether Medicaid payments are or were due and the amounts thereof;

UPDATED PRIOR AUTHORIZATION LIST FOR MEDICAID AND CHILD WELFARE

Effective May 1st

UNITED HEALTHCARE: IMPLEMENTATION OF A NEW REIMBURSEMENT POLICY AND CHANGES TO EXISTING REIMBURSEMENT POLICIES

 Changes to the CCI Editing, DME, Incontinence Supply, Lab

Services, and T Status Codes Policies -Effective August 20, 2016 and Implementation of the new Consultation Services Policy- Effective September 1, 2016 (PDF 282.07 KB)

 Facility Billing Policy Update Reporting an ICD-10 Manifestation

Code as a Primary/Principal Diagnosis - Effective July 1, 2016 (PDF 130.9 KB)

 New Intensity-Modulated Radiation Therapy (IMRT) Reimbursement

Policy - Effective July 1, 2016 (PDF 122.63 KB)

 Changes to the Obstetrical Services and Supply Policies - Effective

May 21, 2016 and Changes to the Inappropriate Primary Diagnosis Codes Policy and Implementation of the New Diabetic Testing Strips and Lancets Policy - Effective June 1, 2016 (PDF 204.94 KB)

UNITED HEALTHCARE: CLAIMS PROCESSING CHANGE FOR EIGHT PROFESSIONAL REIMBURSEMENT POLICIES Anesthesia Policy Assistant Surgeon Policy Bilateral Procedures Policy Global Days Policy Laboratory Services Policy New Patient Visit Policy Professional/Technical Component Policy Rebundling Policy

CLAIMS PROCESSING CHANGE FOR EIGHT PROFESSIONAL REIMBURSEMENT POLICIES - EXAMPLE

New Patient Visit Policy: Currently, when a claim is billed with a new patient evaluation and management code, but member claim history indicates the patient was seen within the past 3 years by the same specialty provider reporting the same TAX ID, the new patient visit code is recoded and reimbursed using an equivalent established patient visit evaluation and management code. With the processing change, the new patient evaluation and management code will be denied indicating the appropriate established patient evaluation and management code needs to be submitted.

Click here for more examples

WEBINAR INFORMATION

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