Rural Health Clinic Division of Medicaid Important Information 2013

  • View
    18

  • Download
    4

Embed Size (px)

DESCRIPTION

Office of the Governor | Mississippi Division of Medicaid. Rural Health Clinic Division of Medicaid Important Information 2013. Kimberley Funchess Facilities and Transportation Programs. RHC basics. Rural Health Clinics. Governing Document: Administrative Code Title 23, Part 212 - PowerPoint PPT Presentation

Transcript

PowerPoint Presentation

Rural Health ClinicDivision of Medicaid Important Information2013Office of the Governor | Mississippi Division of Medicaid

1RHC basicsKimberley Funchess Facilities and Transportation ProgramsOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID2

Rural Health ClinicsGoverning Document: Administrative Code Title 23, Part 212Found on Division of Medicaids Website:www.medicaid.ms.gov

Reimbursement for RHC Services: Funded by Medicare and Medicaid

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID3Rural Health ClinicsProvide to Mississippians:Primary healthcareincluding specialty practice (OB/GYN, pediatric, etc.)Six specified lab tests required on-site urine, HGB/HCT, blood glucose, stool, pregnancy, culturesSupportive services not mandated

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID4Hospital ServicesServices provided in an inpatient or outpatient hospital setting are NOT eligible for reimbursement by an RHC providerThese services must be billed by a qualified, eligible provider using his/her Medicaid provider numberClaims billed by an RHC provider with the following places of service will be denied:POS 21POS 22POS 23

Providers employed by an RHC may render services in an inpatient or outpatient hospital, but the services must be billed by the provider, not the RHC

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID5Service LimitsAll service limits are applicablePhysician visitsDentalVisionMental HealthAdditional benefits are available for beneficiaries who qualify for Expanded EPSDT services.COE limits apply COE 029, 031, 051, 54, 045, 088

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID6Prior AuthorizationAll prior authorization requirements are applicable:DentalExpanded EPSDTPharmacyVision

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID7DocumentationProvider documentation must:Include complete patient recordsVerify appropriate services provided Include date of service, presenting complaint, findings, treatment rendered, provider signatureInclude details such as drug dosages, lab values, radiology reports, etc.Documentation may be audited by DOM or a contracted entity at any timeServices not documented may be subject to recoupment or further investigation by Program IntegrityProviders referred to a regulatory body may be prosecuted for fraud or suffer monetary penalties

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID8Co-minglingDefinition: Simultaneous operation of an RHC and another physician practice, thereby mixing the two practices (share hours of operation, space, staff, equipment, supplies, and other resources).

Physicians and non-physician practitioners may not operate private Medicare and Medicaid practice during RHC hours of operation using clinic resources.

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID9RHC ReimbursementKEY POINTSMarilyn Dickerson, CPC Coding Specialist

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID10RHC Reimbursement

Paid based upon encounter ratesEncounter rates are set for individual providersOne encounter rate per face-to-face visit allowedProvider must bill encounter code to receive reimbursementCodes other than encounter codes will reimburse at a rate of zeroOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID11Multiple Encounters Same Day

Up to four encounters may be reimbursed for the same date of serviceLimited to one encounter for each visit typeMedicalDentalVision/EyeglassMental HealthAdditional medical encounters may be paid on the same date of service by submitting a paper claim with supporting documentationOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID12Encounter Codes

Medical99201 99215 99341 99350 H002399241 99245 99381 99397 H1002999304 99310 99401S91279931559425 59426 S94459931859430T101799324 99337 T1023DentalD0000 D9999 Vision/Eyeglass92002 92014 OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID13Mental Health Encounter Code Changes

Valid for dates of service beginning 1/1/20139078590845 90847 9610190791 90792 908499611090832 90834 908539611190836 90838 9087096118No longer valid after 12/31/201290801 90802 90821 90824 9086590804 90815 908579087690816 90819 9086290899OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID14Obstetrical Billing

Antepartum VisitsCPT codes 99201 99215, 59425 and 59426Visit 1, 2, or 3 one per visit in 99201 99215 rangeVisit 4, 5, or 6 use 59425Visit 7 or more use 59426Postpartum visitsWhen clinic physician is not the delivering physician use 59430Modifiers Include modifier -TH with all antepartum, delivery and postpartum codesOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID15Billing Reminders

RHC should not be listed as the servicing provider on the claimNon-covered and invalid procedure or diagnosis codes will deny if billed $3.00 copay applies, unless exempted by policyNational Correct Coding Initiative Edits (NCCI) do not apply5% assessment does not applyOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID16Additional Billing Informationwww.medicaid.ms.gov/publications.aspx

Provider Reference GuidePart 212 Rural Health Clinics

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID17EPSDT PROGRAMShanda Boarden, RN EPSDT Program

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID18Mississippi Cool KidsEarly and Periodic Screening, Diagnosis and Treatment (EPSDT)Secondary Facility Location Requirements

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID19Enrollment Requirements for Secondary LocationsContact the Bureau of Provider Enrollment at (601) 359-6133 and request to link a secondary location to the primary locations provider facility group number.

The Bureau of Provider Enrollment will notify the requestor that the secondary location has been linked. It is the responsibility of the requestor to contact the Bureau of Medical Services at (601) 359-5565 to request the MS Cool Kids Secondary Location Form. After receipt and approval the requestor will be notified.OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID20

EPSDT Servicing ProvidersThe EPSDT Servicing Provider must be one of the following provider types:

Physician

Nurse Practitioner

Physician AssistantOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID21

Equipment, Supplies, and Other Requirements

Pediatric Scales (Balanced)Adult Scales (Balanced)Equipment to measure heightEquipment to measure infant length and head circumferenceAudioscope or Audiometer, (calibrated annually)Snellen Eye Chart or Titmus MachinePlus LensPediatric Blood Pressure Cuff

Anemia testing machine (HCT/HGB)HCT/HGB equipment calibration logOphthalmoscopeOtoscopeDisposable gloves and Sharps containerUrine dipstick for glucose and protein (Expiration Date)Containers for urine specimen collectionOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID22

Equipment, Supplies, and Other Requirements continued

Developmental Assessment Tool (Denver Kit or Alternative Supplies)Gown and Drapes availableSupplies available to obtain necessary lab (Lead, RPR)Private Medical Record Filing System (HIPPA complaint)Private Exam AreaWaiting room adequate for isolation of well and sick childBathroom and hand washing facilitiesExit doors clearly markedHandicap Ramp or accessFire extinguisherDisaster/Fire plan postedAdministrative Policies, procedure manual, job descriptionsOFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID23