"Medicaid Moving Forward"

I found some great news for adults in AZ in need of Medicaid. Gov. Brewer signed a new law and it looks like many childless adults will be able to qualify for ins by the 1st of 2014. Check out this article and link below!!

Click Here for Direct Link to Article

Medicaid Moving Forward



Background

The Supreme Court ruling on the Affordable Care Act (ACA) provides states multiple and complex opportunities with respect to the future of their Medicaid programs. With these opportunities in mind, Governor Brewer signed into law the AHCCCS Restoration Plan which restores coverage to thousands of Childless Adults and provides coverage for those between 100-133% of the Federal Poverty Level, beginning January 1, 2014. The links below provide detailed information regarding the impact of these provisions to Arizona’s Medicaid program. Additional information will be posted to this page as soon as it becomes available.

The AHCCCS Strategic Plan identifies four goals critical to sustain and build on the success of the AHCCCS program in light of the restoration of coverage -- the most important healthcare policy issue the State has faced since the inception of the AHCCCS program 30 years ago and can be found on the link below:

AHCCCS Strategic Plan 2014-2018



Public Input Process

AHCCCS will be involved in a variety of stakeholder efforts to inform and accept feedback from the public regarding Medicaid Moving Forward. Information will be posted as soon as it becomes available. Questions and comments can be sent to Forward@azahcccs.gov. •Public Meetings New AHCCCS is hosting community meetings across the state to provide the public with information about some of the upcoming changes for Arizona’s Medicaid program. These sessions will also provide the opportunity for AHCCCS to hear from stakeholders, including members and their families, advocates and providers. Space is limited so RSVP is required. Information about these meetings can be found at the link below.

Public Meetings

•Stay Connected

If you would like to receive periodic updates about AHCCCS, implementation, future public meetings or other information, please email Forward@azahcccs.gov. You can also add your name to continue to show support for Restoration and it will automatically place you on the email list. To sign your name in support, please visit the web page below:

I Support Medicaid Coverage



AHCCCS Topics of Interest

•Medicaid Coverage

On June 17, 2013, Governor Brewer signed into law her Medicaid Restoration Plan. Adult coverage will begin January 1, 2014 and applications accepted and processed beginning October 1, 2013. Applicants are encouraged to use the Health-e-Arizona Plus online application to apply. The link below provides background information about how this plan was developed and how it will be funded.

Medicaid Coverage

Hospital Assessment

Moving Forward Presentation

•KidsCare Coverage

Enrollment for Arizona’s CHIP program, known as KidsCare, will remain frozen in 2014 and authority for the KidsCare II program ends December 31, 2013. However, families with income up to 400% FPL may receive premium subsidies for commercial coverage on the Federally Facilitated Marketplace. More information is located on the link below.

KidsCare Coverage

•Health-e-Arizona Plus

AHCCCS and DES are leveraging the current Health-e-Arizona system to comply with new requirements for Medicaid and CHIP eligibility. Health-e-Arizona Plus will be available 10/1/13. Click on the link below for more information.

Modernizing Medicaid IT Systems

•Federally Facilitated Marketplace

On November 18, 2012, Governor Brewer announced that Arizona will participate in a Federally Facilitated Marketplace (FFM). More information on the Governor’s decision can be found below. A link to the Marketplace Subsidy Calculator is also included, which helps estimate premiums and subsidies for people purchasing insurance through the Marketplace. More information on the FFM can be found at www.healthcare.gov.

Marketplace Decision Letter- 11/28/12

Marketplace Subsidy Calculator

Cover AZ

•Essential Health Benefits

Governor Brewer selected the State Employee Benefit- United Healthcare EPO with pediatric, dental and vision coverage supplemented by the FED-VIP as the baseline Essential Health Benefits package for Arizona. The Essential Health Benefits package mandates the minimum services for all commercial policies in Arizona. More information can be found on the links below:

Essential Health Benefits

Governor Brewer Letter 9/28/12

Although Arizona is no longer accepting public comments regarding the Essential Health Benefits Benchmark Plan, a link to the Essential Health Benefits Report can be found below. Comments were originally submitted electronically to: HIX@az.gov.

Benchmark Plan Report

•Federal Interface

CMS has released information regarding the ACA’s provisions and can be found on the links below. Further discussion with CMS will continue and the information posted as soon as it becomes available. More information can be found at www.CMS.gov.

Comments on Proposed Rules

Final Rules

State Plan Amendments

Cigna - Patient Billing Reminder

I received a great piece of news today from Cigna. Their July 2013 Network News article was filled with a lot of good information. This is one piece I thought worth sharing because there is always a question of when and how much to collect from a patient. This helps clarify that for their networks.

Patient billing reminder

It is important to remember that there are program requirements and administrative guidelines in place that include how and when to bill your Cigna patients for covered services. As outlined in the Denied Payment and Participant Non-liability section of the Cigna Reference Guide for physicians, hospitals, ancillaries, and other health care professionals, if these requirements and guidelines are not followed, payment cannot be recovered by charging the patient for the covered services.

Coinsurance plans

For your Cigna patients with a coinsurance plan (a deductible plan or a plan that requires individuals to pay a percentage of the covered charges after meeting the deductible amount), submit claims to Cigna (or its designee). If you used the Cigna Cost of Care Estimator®, you may bill the patient for the amount inidicated as their payment responsibility. Otherwise, you will receive an explanation of payment (EOP) indicating the individual’s payment responsibility. Refer to this EOP before you bill your patients.

Copay plans

For your Cigna patients with a copay plan (a fixed dollar amount they owe per service), the applicable copays may be collected at the time of service. Refer to your patients’ Cigna ID card for the copay amount.

To ensure proper billing, please be aware of these requirements. Log in to CignaforHCP.com > Resources > Reference Guides > Medical Reference Guides > Health Care Professional Reference Guides for information on billing requirements.

http://www.cigna.com/customer_care/healthcare_professional/newsletters/July_2013/billing-0713

AZ BCBS Implementing New Duplicate Denial Reasons

www.azblue.com

I received an email today from BCBS... Good to know info ;-)

Please visit their website or call them if you have any questions or concerns regarding the information listed below.


NEW DUPLICATE CLAIM DENIAL REASONS

BCBSAZ has recently implemented new and more informative duplicate denial reasons. Our hope is that the new denial reasons will provide a better explanation as to why your claim was considered a duplicate and will assist you in determining what action may need to be taken. Please see the attachment for a sample of the new duplicate denial reason code narratives.

When researching a claim that has denied as being a duplicate, please log into “BlueNet” and access the Online Remit link found on the provider portal under the Claims Management tab. Only the online remittance will provide you with the new specific reasons as to why BCBSAZ considered the claim to be a duplicate. The electronic remittance advice (ERA) will only display the ANSI standard duplicate reason code.

After your review, determine what steps may be needed using the instructions outlined below:

• If the original claim information was wrong or in-complete, submit a corrected claim or an E-adjustment. Do not send a new claim.
• Or; if you’ve confirmed the claim was in fact not a duplicate and you believe NO change or correction is required, follow the process for filing a formal grievance.

The process for corrected claims and grievances apply to a single claim for a specific member. However, if you have more than 10 claim corrections and grievances for the same situation please contact your network contract specialist.

BCBSAZ requests that corrected claims and grievances be submitted electronically via the BlueNet provider portal. From the secure provider portal homepage, click on the Claims Management tab. Next, click on the Claim Status link to perform a claim status look up. Select the appropriate claim that you determine needs to be corrected or grieved and then click on either the Claim Action request Form to file a corrected claim or the Appeal Form to submit a grievance.

If you are unable to submit corrected claims or grievances electronically submit a completed Corrected Claim Form or Provider Grievance Form. From the azblue.com “Providers” tab on the public home page on the right side, look under the category Quick Links and select Forms & Resources to be directed to the online forms. The online Corrected Claim and Grievance forms can also be found in the secured provider portal as well as in the Provider Operating Guide.

We encourage providers to file corrected claims and grievances electronically since there are many benefits to filing electronically:

• Reduces paper handling and simplifies the process
• Expedites your request
• Allows provider to attach documentation necessary to support your request
• Allows providers to track Claims Corrections and Grievances submitted via the online Confirmation page

For more details on the types of transactions that can be filed electronically refer to “Doing Business Electronically” and the “Electronic Adjustment User Guide”.

examples of New Duplicate denial Reason codes	Provider Action
BCBSAZ denied this claim because the remarks submitted with the claim show it as a correction to a previously filed claim. It needs to be submitted as an adjustment. Please resubmit this claim using the claim frequency code 7 or 8. Refer to the corrected claim form to see if medical records are also needed.	The duplicate claim was submitted indicating a correction was needed. After reviewing the claim, if a correction is needed providers need to submit a corrected claim or an e-adjustment using the claim frequency code 7 or 8.
BCBSAZdenied payment for this claim as a possible duplicate. BCBSAZ has already processed a claim for this same member, provider, service and date. If the patient was seen more than once in the same emergency room on the same date, the claim should be billed with condition code g0 or modifier 27.	After reviewing the claim it is determined that the patient was seen more than once in the emergency room on the same date, the claim that was denied for being a duplicate should be submitted as a corrected claim adding condition code g0 or modifier 27
BCBSAZ denied payment for this claim as a possible duplicate of a previously processed claim for the same date, provider, and service. Although the prior claim has a different diagnosis, to change the claim, you must submit a corrected claim with medical records, supporting documentation and the reason for the change or correction. BCBSAZ can take no further action on this claim until this information is submitted.	After reviewing the claim if the prior processed claim should have had a different diagnosis submit a corrected claim or e-adjustment. If you’ve confirmed the claim was not a duplicate and no change or correction is required, follow the process for filing a formal grievance. Medical records and/or, supporting documentation must be submitted in both instances.
BCBSAZ has denied this claim as a duplicate of a prior claim for which BCBSAZ requested medical records. BCBSAZ has not received the requested records, and cannot process any claims for these services without those records. Please submit the requested records.	Providers should not submit a new claim. Submit only the medical records requested attached to the letter we sent you requesting the information needed. Please read the record request letter from us carefully and include all items requested.
This is a duplicate of a previously submitted claim for which BCBSAZ requested medical records. We will use the submitted records to complete processing of the initial claim. For record keeping purposes, we must deny this claim as a duplicate, but it will not affect the processing of the initial claim.	Providers should not submit a new claim. The initial claim will be reviewed and determination will be provided after medical review is completed

3 Tips Guide Successful Incident-to Billing

3 Tips Guide Successful Incident-to Billing

March 1st, 2013

Services and supplies properly provided and billed incident-to a physician’s or non-physician practitioner’s services are reimbursed at 100 percent of the Medicare fee schedule amount for Medicare beneficiaries. This provides an opportunity for practices to make the most of their auxiliary staff—but only if they adhere to the Center for Medicare & Medicaid Services’ (CMS) strict incident to requirements. The following quick tips help you cover the basics.
The patient must be established, with an established problem or complaint
Per the Medicare Benefits Manual, Chapter 15, Section 60.1, incident to services “are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.”
Practically speaking, this means the physician or qualified NPP must have seen the patient previously for the problem or complaint for which the incident to service was provided. New patients, or those with a new problem, cannot be seen incident to.
The physician does not have to provide a personal professional service each time the patient is seen incident to, but neither can the physician “turn over” care of the patient to auxiliary staff. He or she must remain directly involved with the patient’s care, or—as the Benefits Manual states—“there must be subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment.”
Services must be medically necessary and appropriate in the physician office
The Benefits Manual states it this way: “Where supplies are clearly of a type a physician is not expected to have on hand in his/her office, or where services are of a type not considered medically appropriate to provide in the office setting, they would not be covered under the incident to provision.”
Direct supervision is required
Incident to coverage “is limited to situations in which there is direct physician supervision of auxiliary personnel,” per the Benefits Manual. Direct supervision means the physician must be present in the office suite and immediately available to provide assistance and direction. The incident to service should be billed in the supervision physician’s name.
Auxiliary personnel means any individual who is acting under the supervision of a physician, “regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician.”

Some very interesting news regarding EHR's and the OIG... See link below
EHR Document Errors

EHR Document Errors Have Caught the Interest of the OIG

You can lower payer audit risk and rejections that are related to insufficient documentation in your electronic health records (EHR) with routine audits that verify who entered the patient information, notes that are distinctive or errors that have been amended.
Documentation of EHR mistakes has captured the attention of the Office of Inspector General (OIG). According to a PartB News article on 10.29.12, from 2009-2011, E/M denials have hovered between 4%-6% for established patients and 9%-10% for new patients. This has prompted the OIG to begin looking at electronic health records of evaluation and management documentation beginning from 2010 for inappropriate payments that result from cloned notes or the same documentation from different patient's record.
Begin Auditing EHR records in these two areas:
User integrity
It's important to know who started the documentation, because a user ID does not let you know which provider ordered a procedure or test due to password sharing.

• User accounts should be set up with different levels of permission and authority that will control who has permission to perform particular functions within the EHR. For instance, medical assistant should not have the ability to alter physician notes or diagnosis, but should be allowed to document things such as patient s immunizations.
• It's important to use your EHR's audit trail to trace your staff access patterns. That function can be used to observe who changed records and to make certain that the staff access only portions of the patient records significant to their job responsibilities.
• Observe documentation for future visits with patient history from 2011 filled in for 2012. For example a patient blood pressure may fluctuate each week, but the record will have the same blood pressure for each visit which will look suspicious to an auditor.
• When you see errors in the medical records make sure to correct them on the spot. If a patient was billed for a procedure or service that they said was not done, make sure to check that the record is correct and look into the complaint. You do not want the patient to call Medicare administrative contractor (MAC) to handle the problem because this can bring on an audit.

Audit integrity

• You should have a designated person to do regular audits of EHR user accounts to ensure that they have access only to areas that relate to their specific duties; which means non-clinicians should not be able to access or amend any patient records. Keeping the numbers of users down to who needs access to the records can avoid any confusion.
• Providers should avoid signing documents without reading it. At times providers will automatically sign documents in EHR just to clear the queue which can lead to problems if records are not read. To avoid this, make sure each provider uses a distinctive signature pin that is not shared; this will force the provider to go into the record and approve it rather then simply clearing the queue.
• Keep an audit of your EHR to ensure that entered information is accurate because medical records are considered binding statement which confirms that all procedures, services, coding and documentation were completed. If the information is incorrect it can by used by the OIG in an audit even if the EHR system is the cause of the error such as with cloned progress notes. It is the responsibility of the provider to correct. If an audit occurs you cannot blame the vendor, because they will deny that it s not their responsibility for medical record accuracy.

Don't assume you have justified medical necessity by providing more information. The information that is documented in the patient note should be detailed and relevant only to the encounter for which the patient is presenting

ICD-10 IMPLEMENTATION NEWS VIA AAPC

ICD-10 Implementation

The US Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 codes, effective Oct. 1, 2014. ICD-10 implementation will radically change the way coding is currently done and will require a significant effort to implement. The time for ICD-10 implementation training is now, and through AAPC, thousands of organizations and individuals have become ICD-10 Implementation Ready


AAPC

GEHA Health Newsletter

http://www.geha.com/Newsletters/Health_eReport/index.asp


February 2013 | Text Version

Heart disease is the leading cause of death for both U.S. men and women. This February, keep your heart in the pink by learning how to manage your cholesterol levels, and by being prepared to recognize the signs and symptoms of a heart attack. This issue of Health e-Report® also includes tips on how to beat the winter blues, information about the risks of adding other people to your financial accounts, an opportunity to receive a free personal wellness report to help you plot a course to better health, and ideas about how to cut calories from a sneaky source – beverages. You’ll also find three delicious new recipes: Greek-style flank steak with tangy yogurt sauce, coconut oatmeal cookies and Mediterranean chicken breasts stuffed with spinach. Consult with your physician before beginning any health, dietary or fitness routine or before incorporating changes or additions to your current health care management program. GEHA presents these articles for informational and educational purposes only and not as professional medical advice.

Featured Topic: Healthy Hearts High cholesterol: What you can do High cholesterol increases your risk for heart disease. People at any age can take steps to keep cholesterol levels normal. Centers for Disease Control and Prevention [Read more] What are the signs and symptoms of a heart attack? Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. National Heart, Lung and Blood Institute [Read more]

Mind & Body: Beat the winter blues: Shedding light on seasonal sadness As the days get shorter, many people find themselves feeling sad. Some people have more serious mood changes year after year, lasting throughout the fall and winter. NIH News in Health [Read more]

Healthy Living: Free personal wellness report Get support to help chart your path to better health. GEHA [Read more]

Dollars & Sense: Adding others to accounts: Understand the risks Consumers often wonder about whether or how to add someone else, usually a relative, to a bank account. These decisions are not to be taken lightly. Federal Deposit Insurance Commission [Read more]

Welcome

The Owner, Staff, and Friends of Simplified Medical Billing would like to welcome you to our new blog. Here we will try to update and post information on current news, regulations, and status' of various topics in the medical billing community. We hope you find the information we provide to be helpful and informative. Thank you for your time and following.

Melissa Rodriguez
www.smb4u.com
Ph: 623-255-8098