2012 Medicaid Provider Updates
- A+ Government Solutions has started requesting medical records from providers for the Payment Error Rate Measurement (PERM) audit. Questions regarding PERM may be directed to the Medicaid Program Audit Coordinator, Larry Stockham, at (701) 328-4831 or firstname.lastname@example.org.
- ND Medicaid has updated the Medical Policy for Positron Emission Tomography (PET) scans. The updated medical policy can be found on the Medicaid Medical Policies page.
- Community-based wrap around services (HCPCS code H2021 in 15-minute increments) is a method of providing mental health services to children. It is an intensive case management model facilitated by a single care coordinator/case manager with a single plan of care.
In previous correspondence, ICD-9-CM dianosis code 799 was provided and was instructed to be submitted in Box 21 as the primary diagnosis code when billing ND Medicaid. Because this is no longer a valid ICD-9-CM diagnosis code, effective immediately, diagnosis 799.9 or any current valid ICD-9-CM diagnosis will now be required.
- Effective January 1, 2013, North Dakota Medicaid will implement lab panel edits for processing professional claims. Per Current Procedural Terminology (CPT), when a lab panel is billed, all components of the lab panel must have been performed; and the CPT Codes within the lab panel cannot be billed separately. If other laboratory tests are performed in conjunction with the lab panel, those tests may be billed in addition to the lab panel.
- Updated Fee Schedules (Basic, Technical, Child & Adult Dental) have been posted on the Provider Fee Schedules page. These went into effect on July 1, 2012.
- Effective November 1, 2012, all service limit providers (Chiropractor, Physical Therapy, Occupational Therapy, Speech Therapy, Psychological therapy and testing) are to use the updated and revised Service Limits Prior Authorization Request form (SFN 481), which can be found online at http://www.nd.gov/eforms/doc/sfn00481.pdf.
- The location of the Durable Medical Equipment (DME) Task Force Meeting has been updated to the 2nd Floor of the Judicial Wing. More information is available on the DME Provider Meetings page.
- A revised MDS 3.0 Submission Guidelines document has been placed on the Provider Manuals page under the Nursing Facility Providers heading.
- A new Medicaid medical policy for Telemedicine is now available on the Medicaid Medical Policy page. Please view that page for more information.
- The next Durable Medical Equipment (DME) Task Force meeting has been scheduled for Thursday, November 15th at 1:00 p.m. in the Fort Totten room. Meeting information can be found on the DME Providers Meeting page.
- ND Medicaid has recently sent out a policy for the 278 Revenue Code billed by hospitals, which will go into effect on January 1, 2013. The mailed documents include the following:
- The ND Medicaid ASC Payment group, Rates, and Codes list has been new updated as the ND Medicaid Outpatient Allowable Procedure List. Please see the Medicaid Provider Fee Schedule page to view.
- A new Web page has been created referencing Dental Coding Guidelines for ND Medicaid billing. Two such guidelines have been posted so far; see the Dental Coding Guidelines page for more information.
- A Medicaid Coding Guideline has also been added regarding Forensic Examination and Interview. Please see the Medical Coding Guidelines page for more information.
- Since March 2012, the Medical Services Division has been operating under a six month Trial Policy for Out of State Services for Children. This trial period is being extended for another six months due to modest numbers of requests received. Please see the attached Notice of Extension of Out of State Trial Policy for more information.
- A correction was made to the 2012 Non-Emergency Transportation Fee Schedule. The non-commercial milage rate has been updated to reflect the accurate amount. This Fee Schedule can be viewed on the Medicad Provider Fee Schedules page.
- Effective September 2012, ND Medicaid will accept enrollment applications from Registered Nurses (RNs) and their employing entities, solely for the purpose of vaccine administration. Please see the attached memo for further guidelines regarding this process: RN Enrollment for Vaccine Administration
- Also effective September 2012, ND Medicaid will be accepting enrollment applications from Clinical Nurse Sepcialists (CNS) and Physician Assistants (PA). Beginning January 2013, Medicaid will no longer allow CNSs and PAs to bill under a supervising physician. Please see the attached letter that was recently sent: CNS and PA Enrollment and Billing
- Attention Medical Providers:
During the August 1, 2012, checkwrite, many professional claims that had been submitted to North Dakota Medicaid received denials with a B7 (THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE ON THIS DATE OF SERVICE). This was a system issue. The Department of Human Services has worked with the Information Technology Department to address the issue for future checkwrites. The Department will reprocess the claims on behalf of providers, so providers will NOT need to resubmit claims. Due to system limitations, the resubmission will happen over a two week period. In addition to the regular checkwrites on August 6 and 13, the Department will be running two additional checkwrites on August 15 and 22. We apologize for any inconvenience this has caused. If you have questions, please contact Provider Relations at 701-328-4043.
- An updated Nursing Facility Rate Setting Manual has been posted on the Provider Manuals page.
- A Clarification Memo has been posted regarding the Ownersehip/Controlling Interest and Conviction Information (SFN 1168) Form required by ND Medicaid Provider Enrollment. The memo can also be found on the various Provider Enrollment Forms Web pages.
- Program Integrity Announcement from CMS:
CMS is pleased to promote two program integrity modules we believe will be informative for you, your counterparts, and association members. The modules are located on the Medscape website at www.medscape.com. The first module, "Reducing Medicare and Medcaid Fraud and Abuse: Protecting Practices and Patients," relates to CMS' provider-focuesed materials in the Fraud Awareness & Prevention Month Toolkit. It is posted at http://www.medscape.org/viewarticle/764496. The second module, "How CMS is Fighting Fraud: Major Program Integrity Initiatives," describes strategies that CMS has undertaken to detect and to prevent fraud and abuse in the Medicare and Medicaid programs. This module is posted at http://www.medscapre.rog/viewarticle/764791. Continuing medical education (CME) credit can be earned for any user registered as a doctor or health care professional. Medscape accounts are free and users do not have to be health care professionals to register for one. Registration is on the landing page of www.medscape.com.
- Two updated fee schedules have been posted on the Provider Fee Schedules page regarding Ambulance and Non-Emergency Transportation.
- A new Medical Coding Guideline has been added to the Coding Guidelines page regarding the Zoster (Singles) Vaccine.
- A number of updated Fee Schedules are now available on the Provider Fee Schedules page (more will be added shortly):
- ASC Payment groups, Rates, and Codes
- Qualified Service Providers (QSP)
- Provider Audit has updated the Provider Report Documents regarding the following facilites: Basic Care, Residential Child Care, Psychiatric Residential Treatment, and Nursing Facilities.
- A number of CPT Coding Guidelines have been retired recently, and can be viewed on the Coding Guidelines page. These include:
- Routine Foot Care
- Botulinum Toxin Type A & B
- Podiatry Billing Guidelines
- A new Provider Newsletter has been mailed out, and is available online on the main Medicaid Provider page. There is an error on Page 1 regarding the July checkwrite dates. There was no scheduled Checkwrite on July 4th, nor is there one on July 5th of this year.
- Updated Checkwrite dates have been posted on the Medicaid Provider Checkwrite Dates page, through September 2012.
- A coding guideline for Tobacco Cessation for Pregnant Woman has been posted to the Medicaid Coding Guidelines page.
- The General Information for Providers manual has been updated with the most current policies. Please see the Medicaid Provider Manuals page for more information.
- The coding guideline for Medical Nutrition Therapy has been updated. It can be accessed on the Medicaid Coding Guidelines page.
- A comment period has been opened regarding the Medicaid policy on Cranial Remolding Orthosis. More information can be found regarding this public comment period on the Durable Medical Equipment Providers main page.
- DME Providers - Please be informed that an updated version of the Certificate of Medical Necessity - Oral and/or Enteral Nutrition (SFN 782) has been posted to e-forms. (www.nd.gov/eforms) Please see #5 of the form with the addition of B4154, as well as #6 with the requirement for documentation to accompany the prior authorization to support pump therapy.
- A link to the Basic Care Provider Agreement (SFN 308) has been added to our Online Forms page for easier access.
- The Pharmacy Drug Utilization Review (DUR) Board pages have been updated with the most current information regarding members and access of information through our partner, Health Information Designs (HID)..
- An updated Dual Diagnosis Screening for Long Term Care manual has been posted on the Provider Manuals page.
- Expanded information regarding ND Medicaid's Health Management Program can be found on the Medicaid Managed Care page.
- An updated Breast Pump policy has been added regarding Durable Medical Equipment (DME). The policy can be viewed on the DME Provider page and also on the Provider Manuals page under the DME Manual heading.
- Policy and Forms Related to Out of State Services for Children:
- Since October 1, 2007, hospitals subject the Inpatient Prospective Payment System (IPPS) have been required to submit information to Medicare specifying whether diagnoses were Present on Adimission (POA). Section 2702 of the Affordable Care Act required that the Secretary of Health and Human Services implement similar provisions for Medicaid.
Hospital Acquired Conditions (HAC)
Effective March 1, 2012, North Dakota Medicaid will be implementing HAC standards that mirror Medicare guidelines and will required all IPPS hospitals to submit claims with the POA indicator.
The ten hospital acquired conditions include: foreign object retained after surgery, air embolism, blood incompatibility, pressure ulcer stages III and IV, falls and trauma, catheter-associated urinary tract infection (UTI), vascular catheter-associated inection, manifestations of poor glycemic control, deep vein thrombosis/pulmonary embolism, and surgical site infections. When a HAC is not present on admission, but is reported as a diagnosis associated with the hospitalization, the Medicaid payment under the IPPS to the hospital may be reduced to reflect that the condition was hospital acquired. If the HAC was present on admission, the Medicaid payment under IPPS to the hospital would not be reduced. If applicable, North Dakota Medical Services will be changing the payment based on the POA indicator during a retro-review of claims.
Provider Preventable Conditions
Medicaid also identifies the following provider-preventable procedures for nonpayment: performance of wrong surgical or other invasive procedure performed on correct patient; performance of surgical or other invasive procedure performed on the wrong side/body part; performce of surgical or other invasive procedure performed on the wrong patient/patient not scheduled for surgery.
If you have questions on the above mentioned matter, please contact North Dakota Medical Services to speak with a Medical Coding Specialist at 1-800-755-2604.
- A revised policy has been created for Incontinent Garments. Please see the Durable Medical Equipment page for more information.
- A new medical policy has been posted for Gene Expression Profiling. This new policy can be found on the Medicaid Medical Policy Web page.
- There have been udpates to the Durable Medical Equipment (DME) Fee Schedule. Also, a new policy for Enteral Nutrition has been posted. All of these updates may be found on the DME Provider Web page.
- The date/time for the next DME Task Force Meeting has been changed. Please see the DME Meetings page for more information.
- Effective March 1, 2012, North Dakota Medicaid will implement the following Local Coverage Determination (LCD) policies as published by CMS:
- Application of Bioengineered Skin Substitutes: Ulcers (of Lower Extremities)
- Blocks and Destruction of Somatic and Sympathetic Nerves
- Botulinum Toxin Types A and B
- Brachytherapy: Non-Intracoronary
- Cytogentic Studies
- Erythropoiesis Stimulating Agents (ESAs)
- Genetic Testing
- Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes, and Morton's Neuroma
- Lumbar Facet Blockade
- Mohs Micrographic (MMS) Surgery
- Polysomnography and Other Sleep Studies
- Radiation Oncology: External Beam/Teletherapy
- Routine Foot Care
- Sensory Evoked Potentials & Intraop Neurophysiology Minitoring
- Skin Lesion Removal (Includes AK and Excludes MOHS)
- Symptomatic, Pathological Nail and Its Treatment
- Treatment of Ulcers & Sumptomatic Hyperkeratoses
- Treatment of Varicose Veins of the Lower Extremities
- Vertebroplasty, Vertebral Augmentation; Percutaneous
- Vitamin D Assay Testing
ND Medical Services - Utilization Revew will accept comments through the end of business on February 24, 2012. Comments may be faxed to (701) 328-1544, Attn: ND Medical Services-Utilization Review Team.
- DHS implemented the X12 Version 5010 software on January 2, 2012. In order to ensure claims from providers can be processed, DHS will continue to support X12 Version 4010 transactions after the Department's X12 Version 5010 solution is implemented.