Friday, May 3, 2019 9:00 AM 12:30 PM Location: The Department of - PowerPoint PPT Presentation

Friday, May 3, 2019 9:00 AM – 12:30 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# Topic Suggestions, due by close of business one week prior to the meeting. Send suggestions to Elizabeth Quaife at elizabeth.quaife@state.co.us 1

Welcome & Introductions Thank you for participating today! • We are counting on your participation to • make these meetings successful [Poll] 2

• WE WILL BE RECORDING THIS WEBINAR. • ALL LINES ARE MUTED. PRESS *6 IF YOU WISH TO UNMUTE. PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT WINDOW • If background noise and/or inappropriate language occurs all lines will be hard muted. • Please speak clearly when asking a question and give your name and hospital 3

Overview of the Day • Hospital Engagement Meeting 9:00-12:30 • Coffee Break TBA 4

HOSPITAL ENGAGEMENT MEETING TOPICS 5/3/2019 9:00am-12:30pm - NPI Law - Announcements/Pending Items - Medicare Crossover Workaround Quick Update - Inpatient Engagement Meeting Topics Received - CC/CCEC Enrollment Update - Inpatient Base Rates Fiscal Year 2019-20 Removed - Separating Mom and Baby Claims - Outpatient Engagement Meeting Topics Received - 3M Module Update - JW Modifier SCR - Outpatient Hospital Survey 5 Colorado Department of Health Care Policy and Financing

Dates and Times for Future Hospital Stakeholder Engagement Meetings in 2019 Dates of Meetings Meeting Time January 11, 2019 12:30 p.m. – 4:00 p.m. March 1, 2019 9:00 a.m. – 12:30 p.m. May 3, 2019 9:00 a.m. – 12:30 p.m. July 12, 2019 12:30 p.m. – 4:00 p.m. September 13, 2019 12:30 p.m. – 4:00 p.m. November 1, 2019 9:00 a.m. – 12:30 p.m. The agenda for upcoming meetings will Please note the offset be available on our external website on dates and times to work a Monday the week of the meeting. around holidays AND https://www.colorado.gov/pacific/hcp Medical Services Board f/hospital-engagement-meetings 6

July 12, 2019 Hospital Stakeholder Engagement Meeting will start at 12:30pm Reminder: The date and time is offset to accommodate the Fourth of July holiday and Medical Services Board held in the morning. 7

Colorado NPI Law Chris Underwood 8

Revalidation & Colorado NPI Law Colorado NPI Law Revalidation • Organization Health Care Providers (not individuals) must obtain and • At least every 5 years use unique and separate National Starting April 2020 • Provider Identifier (NPI) for each • A six (6) month notice via Service Location and Provider Type email in advance of their ▪ Impacts both Enrollment & Claims enrollment deadline • New Providers & Sites: Jan 2020 • Action: Update email Current Providers: Jan 2021 • addresses in provider enrollment profiles to Draft Rules for Review • receive these notices Now available on our website For questions regarding the Colorado NPI Law, email ColoradoNPIlaw@state.co.us Or visit https://www.colorado.gov/pacific/hcpf/colorado-npi-law 9

Behavioral Health Hospital Engagement Forum Thank you for your participation on March 1, 2019 Engagement meeting. The Behavioral Health group has started their own meeting series and Meeting Webpage. The meetings will be held the third Friday of every month starting May 17, 2019. To be added to the communication list please contact Rosanne Surine at rosanne.surine@state.co.us. Behavioral Health Hospital Engagement Forum Webpage *A link has been added to the bottom of the Hospital Stakeholder Engagement Meeting webpage as well. 10

Prior Authorization Request (PAR) and Inpatient Hospital Review Program (IHRP) Unfortunately a representative was not available to join us today. However, the PAR/IHRP team would like to share the following resources: For information regarding the PAR program including policy and How to Guides please visit the Colorado PAR Website. For additional questions/clarifications please email the IHRP Inbox at: HCPF_hospitalreview@state.co.us Go Live is currently scheduled for May 15, 2019. Additional training opportunities will be announced on their website. If you would like to arrange a personalized webinar for your facility, please email the IHRP inbox listed above. 11

Quick Contact Reminder Inpatient Hospital Rates – Inpatient APR-DRG Rates - Contact Diana Lambe at diana.lambe@state.co.us Inpatient Hospital Per Diem Rates – Contact Elizabeth Quaife at elizabeth.quaife@state.co.us Outpatient Hospital Rates (EAPG Rates Only) - Contact Andrew Abalos at andrew.abalos@state.co.us FQHC/RHC Rates – Contact Erin Johnson at erink.johnson@state.co.us 12

Inpatient Topics/Questions Submitted Topic Brief Description Status Medicaid as tertiary payer Providers receiving payments Being investigated with resulting in overpayment and Systems, Policy and Rates returning amount to Medicaid Prior Authorization Program General Questions with go live Reached out to the PAR group (PAR) occurring 5/15/2019 whom provided information. (completed) 13

Medicare Crossover Workaround Quick Update Department SCR prioritization is re-evaluated every two weeks. The Department considers factors such as: ➢ financial risk, ➢ impact on providers, ➢ relative magnitude, etc. The Department is committed to moving forward with these important changes, and will continue to provide updates as they are available. SCR Prioritization Priority #2 , on hold until Inpatient PAR is Medicare Crossover Claims implemented Priority #7 , on hold until Inpatient PAR is IPP-LARCs implemented Per Diem Hospital Rates (LTACs/Rehabs) Priority #24 Observations over 24 hours/24-48 hours Not Yet Prioritized JW Modifier Not Yet Prioritized 14

Community Clinic and Community Clinic and Emergency Center (CC/CCEC) Reminder The CC/CCEC rule became effective November 30, 2018. The adoption of this rule eliminated the temporary provision for locations licensed as CC/CCECs to be enrolled as and/or bill under the hospital provider type. 51 +/- Total Number of Clinics Licensed by CDPHE 5 Enrollment Applications Returned to Provider for Additional Info 20 +/- No CCEC Enrollment Attempts 24 Clinics Currently Enrolled as CCECs 15

Separating Baby from Mother’s Claim How do we estimate the DRG-SOIs for 16,811 missing well- baby claims? CLAIM TYPE CLAIM COUNT OLD PMT EST NEW PMT DIFFERENCE Delivery DRGs 22,524 $$$$$ $$$$$ Neonate DRGs 5,713 $$$$$ $$$$$ Estimated Missing Well- Baby Claims using 640-1 16,811 $0 $$$$$ and FY19 Rates TOTAL 45,048 $$$$$ $$$$$ $0 16

Separating Baby from Mother’s Claim SOI APR DRG Description TOTAL 1 2 3 4 589 NEONATE W OTHER SIGNIFICANT PROBLEMS 0.06% 0.06% NEONATE BIRTHWT 1500-1999G W MAJOR 611 0.06% 0.06% ANOMALY This is the NEONATE BWT 1500-1999G W OR W/O OTHER distribution 614 0.41% 0.41% SIGNIFICANT CONDITION from ONE hospital. 621 NEONATE BWT 2000-2499G W MAJOR ANOMALY 0.23% 0.06% 0.29% NEONATE BWT 2000-2499G W OTHER SIGNIFICANT 625 0.06% 0.00% 0.06% CONDITION NEONATE BWT 2000-2499G, NORMAL NEWBORN 626 0.47% 1.75% 2.05% 4.27% OR NEONATE W OTHER PROBLEM 633 NEONATE BIRTHWT >2499G W MAJOR ANOMALY 2.57% 0.23% 2.81% NEONATE, BIRTHWT >2499G W RESP DIST 634 0.06% 0.06% SYND/OTH MAJ RESP COND NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT 639 0.06% 0.12% 0.18% CONDITION NEONATE BIRTHWT >2499G, NORMAL NEWBORN 640 42.78% 33.84% 15.20% 91.82% OR NEONATE W OTHER PROBLEM 46.70% 36.00% 17.24% 0.06% 100.00% 17

Outpatient Topics/Questions Received Inquiries were not received or none currently pending. 18

EAPG Module Updates • GPS v2019.1.0 Installed March 30, 2019 ▪ EAPG Grouper recognizes 4/1/2019 quarterly update to CPT/HCPCS ▪ Version 3.10 remains in use • Similar scheduling for GPS v2019.2.0 ▪ No exact date on 3M site – late June 2019 anticipated ▪ No planned updates to grouping methodology ▪ 7/1/2019 quarterly CPT/HCPCS updates 19

Brief EAPG Rate Update • Annual rate change effective July 1, 2019 • No rule change required • SPA update required, all rate updates pending CMS approval • Online rate posting by 6/1/2019 for consistency with 7/1/2018 timeline of implementing rate change prior to rate effective date 20

JW Modifier SCR • Background: Items billed with the ‘JW’ Modifier (discarded portion of drugs) generated payment in interChange system ➢ Although requested to be billed, is not intended to have EAPG Payment • SCR 44898 Created ➢ Not yet prioritized ➢ Once implemented, claims with DOS 10/31/2016 billed with JW modifier will be adjusted to pay properly 21

Outpatient Hospital Survey • So liciting input from stakeholders to inform policy decisions, available until May 24, 2019 • Intended for those most familiar with overall financial and operational needs ➢ Billing practices ➢ Health needs of respective community • https://www.surveymonkey.com/r/NW5HPGB 22

Questions, Comments, & Solutions 23

Resource Links • Inpatient Hospital Rates Webpage Link • Outpatient Hospital Rates Webpage Link • Hospital Engagement Meeting Webpage Link • UB-04: IP and OP Billing Manual Webpage Link • Inpatient Per Diem Reimbursement Group Webpage Link 24