HOSPITAL ENGAGEMENT MEETING Friday, March 2, 2018 9:00 AM – 12:00 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# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Overview of Meetings • General Hospital Meeting 9:00-10:00 • Break 10 min. • General Hospital Meeting cont’d 10:10-12:00 • Lunch Break 12:00-1:00 • Specialty Hospital Meeting 1:00-2:00 • EAPG Engagement Meeting 2:00-4:00 2
3 Colorado Department of Health Care Policy and Financing
GROUND RULES FOR WEBINAR WE WILL BE RECORDING THIS WEBINAR • ALL LINES ARE MUTED. PLEASE UTILIZE WEBINAR CHAT • WINDOW Please speak clearly when asking a question and give your • name and hospital If you wish to utilize the conference line for speaking, please • submit the request through webinar chat window. We will temporarily mute the microphones and activate the conference line. This may take a few moments. 4
Welcome & Introductions Thank you for participating today! • We are counting on your participation to • make these meetings successful 5
Dates for Future Hospital Engagement Meetings in 2018 1/12/2018 • The agenda for upcoming meetings will be available on our external website in advance 3/2/2018 • of each meeting. https://www.colorado.gov/pacific/hcpf/hos pital-engagement-meetings 5/4/2018 • Registration links for each session during the day will also be available prior to the meeting. 7/13/2018 • Just click on the links to register for each session and you will receive the link to 9/7/2018 • connect to the webinar. Meetings will now begin at 9am starting with 11/2/2018 • 11/3/2017 meeting 6
Specialty Hospital Meetings Specialty Hospital Engagement Meetings 1/12/2018 1pm-2pm CANCELED 2/2/2018 1pm-2pm CANCELED 3/2/2018 1pm-2pm 4/6/2018 1pm-2pm • Updates on Budget Neutral Proposal Updated goals and Timelines • 7
Escalation Process • Escalated Claims should include a Call Tracking Number (CTN) • If a CTN is not included in an escalation, Provider may be referred back to DXC Call Center • Requesting Providers to use channels currently open to them. • Established Provider and Department meetings • Engagement Meetings • Escalating to correct team Escalating to correct team after utilizing DXC call center: • Rates Team: inquiries where the reimbursement is incorrect related to base rate or Provider calculated reimbursement is different then received. Provide calculation and difference when escalating if DXC is unable to assist. • Operations: Escalate claim examples when requested by representative • Policy: Escalate claim examples when requested by representative 8
Escalations Continued • If a claim is raised to a Department team, please do not escalate it to other Department groups • Multiple escalations of same claim can result: • In different solutions • Different solutions may cause a conflict with another solution • Multiple requests for same issue with same fix can create multiple work orders which delays the correction process. • Department is still receiving multiple escalations for the same claim/issue from multiple representatives within a Provider community. Examples include: • Escalation of claim/issue from multiple people to one Department member • Escalation of claim/issue to multiple Department members on the same team by an individual or multiple personnel AND/OR • Escalations of same claim/issue to multiple Department members on different teams. All of the above examples can cause delay in response, action and removes resources from Projects and normal operations. 9
Escalations Continued If unsure whom to escalate a claim to, please email potential Department representatives on one email . Do not send individual emails to each representative. A single email will allow the Department to assign the escalation to the appropriate person and prevent duplicate emails from being sent. If a claim or issue has been escalated and a response has not been received and it is being escalating to a new individual within the Department, please include the original representative the claim/issue was escalated to. This allows the new representative to reach out to the original representative to check if it is being worked on. If an escalation has been sent, please proceed as follows: Follow up with the Department Representative the claim was escalated to OR If forwarded to a different Department Representative to assist with the claim, please follow up with the new Representative working on the claim. 10
Medicare Crossovers – Part A or Part B Only Inpatient Medicaid with Medicare Part B only* • Part B causing error code to bill Medicare first even though Inpatient claim is not eligible for Part B services (outpatient only) • Department is aware and already has several examples of the issue. Rates is currently working with multiple teams to correct Inpatient claims from bumping against Medicare Part B only Outpatient Medicaid with Medicare Part A only* • Part A causing error code to bill Medicare first even though Outpatient claim is not eligible for Part A services (Inpatient only) • Systems sent correction and completed Dec/Jan. Mass adjustment has been completed. *Please do not escalate any additional claim examples 11
Reminder for Filing Medicare Crossover Claims • Utilize the appropriate Crossover Claims option and enter correct data into each applicable field • Do not add Medicare Payment into Third Party Liability (TPL) or Other Government Insurance box. This results in deduction of Medicare Payment twice. Other Government Insurance Third Party Liability 12
Type of Bill 12X • Inpatient Hospital (Medicare Part B only) • Initial Department plan to pay these claims using crossover claim payment policies • Part B Only (TOB 12X) – assessing variety of solutions with attention to complexity / timeliness of implementation ▪ Denying 12Xs Not Feasible option for proper reporting ▪ Solutions being assessed – minimum 6 months 13
Transportation at Discharge If a member requires Non-Emergent Medical Transportation (NEMT) at discharge, plan ahead to help prevent extended waiting times or denial of services. The Department will be issuing a Provider Bulletin Article in the near future. 14
Admin Date/From Date • From Date or Procedure code date is before Admit Date (24- hour Bundling policy) • EOBs: 1730, 1731, 1393, 1395, 1920, 1930 and 1702. • Issue has been resolved and claims that denied for these EOBs have been reprocessed. ➢ A small amount of claims are still waiting to be reprocessed because of the circumstances that had a 48-hour stay for Observation. 15
Pending Additional Research and/or Actions The following items have been discussed at previous meetings and are pending while additional research and/or processes are being completed • Exhausted Medicare Benefits on Crossovers • IPP-LARCs • Interim Billing • Professional Fees 16
EAPG Monthly Meetings 2018 Meetings, Conference Room 7B, 2:00pm-4:00pm 03/02/2018 03/30/2018 05/04/2018 06/01/2018 NOTE: There are no meetings in April Please Note: Future 2018 Meetings will be held at 303 E. 17 th Ave Denver Conference Room 7B 17
Agenda for EAPG Meeting • Drug Payments in EAPGs ➢ Upcoming Rule Change – Details at https://www.colorado.gov/pacific/hcpf/outpatient-hospital- payment • EAPG Grouper Version ➢ New set of Payer Exceptions not functioning correctly ➢ Impacts claims using X Modifiers 18
Agenda for EAPG Meeting • Mass Adjustment Updates ➢ Testing 12,900 claims for EAPGs processed in Xerox system ➢ Aiming for March / April completion, depending on results • Policy clarification regarding Recurring Visits • Questions and comments regarding EAPG payments, billing, etc. 19
Recurring Visits Clarification and ED/Observation Billing • Emergency Room visits should not be included on outpatient claims describing recurring visits (regularly scheduled visits for ongoing treatment, such as physical therapy or oncology treatment). Emergency Room visits should be billed separately in order for the EAPG grouper to calculate payment appropriately per claim and visit. Recurring visits which may include Observation services should have each visit billed separately to avoid unintended bundling during payment calculation. 20
Newborn/Live Birth Diagnosis Codes Two Issues: 1. Three Newborn/Live Birth Diagnosis codes disallowed as Principal/Primary Diagnosis on interChange system. a) Claims from 3/1/2017 – present with a primary diagnosis code of Z381, Z384, or Z387 were mass adjusted mid-February. If you still see problems, please contact diana.lambe@state.co.us. 2. 3M APR-DRG Grouper limits allowance of Newborn/Live Birth Diagnosis Codes as the primary diagnosis based on age in days of child upon admission. 21
Newborn/Live Birth Diagnosis Codes 22
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