Hospital Utilization Review Stakeholder Meeting Office of Inspector - PowerPoint PPT Presentation

Hospital Utilization Review Stakeholder Meeting Office of Inspector General Medicaid Program Integrity Division Medical Services January 21, 2020 OIG Fraud Hotline: 800-436-6184 1

Office of Inspector General (OIG) Reviews • Review of Emergency Room / Outpatient Claims associated with Inpatient Stays OIG Fraud Hotline: 800-436-6184 2

SharePoint Update • Use of the SharePoint External Transfer Site continues to increase. • To request access, send an email to oigsharepoint@txhhs.onmicrosoft.com and tell us: who you are, the organization you represent, and why you need access. Action on your request maybe delayed, if this information is incomplete. OIG Fraud Hotline: 800-436-6184 3

Samples • The next Fee-For-Service Sample will be released in February 2020. • Development of the next Managed Care Sample is planned to begin in February. OIG Fraud Hotline: 800-436-6184 4

Managed Care Organization Update • A request to the MCOs was sent on December 20, 2019 requesting payment methodology for potential denials for the first sample. OIG Fraud Hotline: 800-436-6184 5

Coding Trends • Use of code P00.2 Newborn (suspected to be affected) by maternal infectious and parasitic diseases. • 0CB7XZZ Excision Of Tongue External Approach vs 0CN7XZZ Open Release Of Tongue Tie OIG Fraud Hotline: 800-436-6184 6

Thank You Johanna Fite-Sagredo RN, BSN Manager V Hospital/Lock-In Program Medical Services, Medicaid Program Integrity Johanna.Fite@hhsc.state.tx.us OIG_UR@hhsc.state.tx.us To Learn more about the Office of Inspector General: Website: ReportTexasFraud.com Facebook: www.facebook.com/TxOIG Twitter: twitter.com/TexasOIG OIG Fraud Hotline: 800-436-6184 7