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IHCP Updates HP Provider Relations/March 2014

IHCP Updates March 2014 2

Agenda • Changes to CMS-1500 Claim Form • Changes to UB-04 Claim Form • Hospital Assessment Fee • Family Planning • ICD-10 • W-9 • Helpful Tools • Q&A


Objectives

This session will keep providers current on some of the more recent developments concerning the Indiana Health Coverage Programs (IHCP). It is critical for providers to develop and maintain up-to-date knowledge about the rapidly changing environment in the Medicaid program.

Changes to CMS-1500 Claim Form


The Revised CMS-1500 Claim Form

• Both current and revised forms will be accepted during a transition period from January 6, 2014 through March 31, 2014

• The effective dates for transition to the new form

are based on date of claim submission rather than date of service


The Revised CMS-1500 Claim Form • Effective April 1, 2014, the Indiana Health Coverage

Programs (IHCP) will accept only the revised version of the CMS-1500 (02/12) paper claim form

• Paper claims submitted on the current version of the CMS-

1500 (08/05) after March 31, 2014, will not be processed and will be returned to the provider


The Revised CMS-1500 Claim Form

• BT201353 Provides: - Time line for transitioning to the revised

CMS-1500 paper claim form - CMS-1500 claim form Instructions - CMS-1500 (02/12) claim form field

descriptions

Changes to UB-04 Claim Form


ICD indicators on UB-04 paper claim forms

• In preparation for the ICD-10 mandate, the Indiana Health Coverage Programs (IHCP) will require the use of ICD indicators on all paper claims submitted on the Uniform Billing (UB-04) claim form effective January 6, 2014

• Paper claims received without ICD indicators or with invalid ICD indicators after January 5, 2014, will not be processed and will be returned to the provider



• The effective date for this requirement is based on the date of claim submission rather than date of service

• The current version of the UB-04 paper claim form will continue to be used • Form locator field 66 will be a required field as of January 6, 2014 • The appropriate ICD indicator must be entered:

- Enter the number “9” to indicate ICD-9. - Enter the number “0” to indicate ICD-10.


Care Select certification codes • Care Select discontinued the use of certification codes for all claims with

dates of service on or after January 1, 2011 • Providers were no longer required to submit the certification code for dates

of service on or after January 1, 2011 - Cert codes went in Field 19 of the CMS-1500 form - Cert codes went in Field 37 of the UB-04 form

• Effective January 6, 2014, certification codes are no longer a requirement regardless of the date of service

• The following edits will be deactivated: - Edit 1047 − The certification code is missing - Care Select. Please verify and

resubmit. - Edit 1048 − The certification code is invalid - Care Select. Please verify and

resubmit.

Hospital Assessment Fee (HAF)


Resumption of Hospital Assessment Fee (HAF)

• HAF rates for hospitals and capitated rates for managed care entities (MCE) will resume - Effective retroactive to July 1, 2013 - Will continue through June 30, 2015

• HAF resumption will continue the collection of an assessment fee from eligible hospitals - The fees are used to increase reimbursement to eligible hospitals in

both the fee-for-service and managed care programs - The fees are used as the state’s share of disproportionate share

hospital (DSH) payments


HAF – eligible and ineligible hospitals

• Eligible hospitals - In-state acute care hospitals licensed under IC 16-21-2 - Freestanding psychiatric hospitals licensed under IC 12-25

• Ineligible Hospitals - Long term acute care (LTAC) hospitals - State-owned hospitals - Hospitals operated by the federal government - Freestanding rehabilitation hospitals - Out-of-state hospitals


HAF - reimbursement changes • The increases in inpatient and outpatient reimbursement will result in

aggregate payments that reasonably approximate the Medicare upper payment limits, without exceeding those limits

• Increases in reimbursement will be based on the following adjustment factors:

- Inpatient diagnosis-related group (DRG) base rate: 3.0 - Inpatient rehabilitation level of care (LOC) rate: 3.0 - Inpatient psychiatric LOC rate: 2.2 - Inpatient burn LOC rate: 1.0 - Outpatient rates (excluding laboratory): 3.2

Note: These adjustment factors may be revised in the future, in order to remain within the upper hospital payment limit.


HAF – reimbursement changes • For inpatient claims:

- The adjustment factors will apply to claims with “from” dates of service on or after July 1, 2013

- Inpatient admissions that occurred prior to July 1, 2013, will not receive the hospital assessment fee (HAF) increase, even if the discharge date is after July 1, 2013

• For outpatient claims: - The adjustment factors will apply to claim detail lines with dates of service on or

after July 1, 2013 - Outpatient laboratory services (codes listed on the Medicare Clinical Laboratory

Fee Schedule) are not subject to the HAF increase NOTE: For hospitals participating in HAF, the 5% inpatient and outpatient reductions will not apply while HAF is in effect, except for outpatient laboratory services.


HAF – retroactive adjustments • Retroactive adjustments will be processed to adjust

previously paid claims, retroactive to July 1, 2013 • Mass adjustment claims will appear on remittance

advices beginning on or after TBD • Mass adjustment claims are identified with a region

code of 56 (first two digits of ICN [internal control number])

• Mass adjustments will be processed in the following order:

- Inpatient claims - Inpatient crossover claims - Outpatient claims - Outpatient crossover claims


HAF – remittance advice information • ARCS code 169 indicates HAF payment

- DRG base payment amount $9,172.69 - DRG capital cost $645.00 - DRG medical education cost $208.40 - HAF payment (3 X DRG base – DRG base) $18,345.38 - Total reimbursement $28,371.47

Family Planning


Family Planning Eligibility Program • The IHCP implemented the Family Planning Eligibility Program, effective

January 1, 2013, to qualifying individuals • The family planning eligibility category includes individuals who:

- Do not qualify for any other category of Medicaid - Are male or female of any age - Are not pregnant - Have not had a hysterectomy or sterilization - Have income that is at or below 141% of the federal poverty level - Are U.S. citizens, certain lawful permanent residents, or certain qualified

documented aliens • Members eligible under the Family Planning Aid Category will receive

services through the Traditional Medicaid fee-for-service delivery system • Providers must check eligibility before rendering services


Web interChange Eligibility Inquiry


Charging the member for non-covered services

• If a member eligible under the Family Planning Eligibility Program chooses to have services that are not related to family planning, and therefore not covered, a waiver must be signed by the member and the member may be billed for the service The waiver is used to document that a member had been informed a service is non-covered

• The waiver must not include “conditional language” and must be specific about the services rendered that are non-covered

• Refer to IHCP Provider Manual, Chapter 4, Section 6 – Charging Members for Non Covered Services


Services Covered

• Annual family planning visits • Limited history & physical

examinations • Laboratory tests if medically

indicated as part of the decision making process for contraceptive methods

• Pap smears • Follow up care for complications

associated with contraceptive methods

• Initial diagnosis and treatment of STD and STI

• Screening, testing, counseling and referral of members at risk for HIV

• Tubal ligations • Hysteroscopic sterilization with

implant device • Vasectomies • FDA approved oral contraceptives

and contraceptive devices

Services are for the primary purpose of preventing or delaying pregnancy


Procedure and diagnosis codes

• Services must be billed with family planning diagnosis and procedure codes

• Provider bulletin BT201301 contains detailed information about procedure codes, diagnosis codes, modifiers and error codes

• For additional information refer to: - Bulletins BT201303, BT201318, BT201357 - Banner BR201326 - IHCP Provider Manual Chapter 2 and Chapter 8

ICD-10 International Classification of Diseases - Tenth Revision


ICD-10 Implementation • The implementation date is October 1, 2014, with no

exceptions • As of April 1, 2014 only 183 days remaining • Visit the ICD-10 Information Page for extensive information:

http://provider.indianamedicaid.com/general-provider-services/icd-10-information.aspx

• There is a power point presentation entitled “ICD-10 Compliance Project” which is updated monthly: http://provider.indianamedicaid.com/media/103157/icd-10%20compliance%20project%20status%2020130901.pdf




ICD-10 Paper Claim Form updates

• CMS-1500 (version 02/12) - January 6, 2014: Providers began using the new form - January 6 through March 31, 2014: Providers may use the previous form

(version 08/05) or the new form - April 1, 2014: Providers may only use the new form - For more information refer to Provider Bulletin BT201353

• UB-04 - The claim form is not being updated for ICD-10 but providers are required to

use ICD-9 or ICD-10 indicators, beginning January 6, 2014 - For more information refer to Provider Bulletin BT201352

http://www.indianamedicaid.com/ihcp/Bulletins/BT201352.pdf


ICD-10 Vendor Testing • The IHCP is testing ICD-10 system changes with

vendors • ICD-10 vendor testing is scheduled for March – July

2014 • This testing is designated for claims processing and

end-to-end testing, including testing with the new APR-DRG grouper, new and updated policies, and Myers and Stauffer rate updates

• Clearinghouses and software vendors may request the adjudication results of test claims submitted


ICD-10 Keys to Success

• Stay current on postings and announcements on the ICD-10 information page at indianamedicaid.com

• Take part in IHCP outreach efforts including workshops and conferences • Attend professional association meetings • Be proactive – if you have not started your planning and assessment, begin

now • If you have not been contacted by your vendors, contact them • Set aside a block of time each day, no matter how small, to work on ICD-10

http://www.indianamedicaid.com/


ICD-10 Keys to Success

• Become familiar with ICD-10 code sets now • If you are a coder, you may be required by your

certifying body to demonstrate ICD-10 proficiency to renew your certification

• Analyze the codes that are used most frequently in your office

• Code one claim per day from ICD-9 to ICD-10 • Do not put off purchasing the ICD-10 code books

Form W-9 Request for Taxpayer Identification Number and Certification


Form W-9

• Incorrect or missing W-9 form is one of the top reasons for provider enrollment documents to be returned to provider (RTP’d)

• The most current version of the W-9 must be used (available at www.irs.gov)

• The W-9 legal name must match the legal name on the application • The W-9 business name/disregard entity name must match the DBA on the

application • The W-9 address must match the home office address on the application • The W-9 signature must be an owner, board member or manager listed on

Schedule C.1 and/or C.3 (delegated administrator signature is not allowed)

http://www.irs.gov/

Helpful Tools


Helpful Tools • IHCP website at indianamedicaid.com • Indiana Medicaid Provider Manual • Electronic Solutions Service Desk

- 1-877-877-5182 (toll-free) - (317) 488-5160 (local) - [email protected]

• Customer Assistance - 1-800-577-1278 (toll-free, use in Indiana [except 317 area code], Illinois,

Michigan, Ohio and Kentucky) - (317) 655-3240 (use in all other areas) - Provider Relations field consultant - provider.indianamedicaid.com/contact-us/provider-relations-field-consultants.aspx

• Written Correspondence - HP Provider Written Correspondence

P. O. Box 7263 Indianapolis, IN 46207-7263

http://provider.indianamedicaid.com/

http://provider.indianamedicaid.com/contact-us/provider-relations-field-consultants.aspx

title (46 pt. hp simplified bold) - inprovider.indianamedicaid.com/media/125017/updates q1...

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