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ND Medicaid Provider Updates

Posted 6-26-2017

The Centers for Medicare and Medicaid Services (CMS) has issued a requirement that goes into effect for North Dakota Medicaid members on July 1, 2017. The rule requires for the initial ordering of home health services (nursing services and home health aide services), physicians or certain authorized non-physician practitioners (NPPS) must document that a face-to-face encounter, which is related to the primary reason the beneficiary requires home health services, occurred no more than 90 days before or 30 days after the start of home health services.

This face-to-face encounter may be performed by a physician, nurse practitioner, clinical nurse specialist or physician assistant, all who must be working under the supervision of a physician. The practitioner performing the face-to-face must communicate the clinical findings of the encounter to the ordering physician. Communication between the practitioner conducting the face-to-face and the ordering physician is to be documented in the medical record.

Medical necessity for the home health services must be supported in the medical record. The visit may be performed via telehealth or in person; telephone encounter is not sufficient.

Posted 6-22-2017

ND Medicaid Policy – Revenue Code 278

Revenue Code 278: Medical/Surgical Supplies: Other implants
Effective Date: January 1, 2013
Amended Date: July 1, 2017

  • Code indicates charges for supply items required for patient care
  • Revenue code 278 always requires a valid HCPCS on outpatient claims

Inpatient Hospital Claims

  • This policy applies to all hospitals reimbursed on a cost-to-charge ratio for inpatient services.
  • Billed charges over $15,000.00 for revenue code 278 will require a vendor’s invoice to support supplies used that correspond to the services rendered.
  • The HCPCS code associated with each detail line billed with revenue code 278 must be clearly illustrated on the vendor’s invoice(s) submitted with the claim. If the supplies on the invoice do not match the HCPCS billed under revenue code 278 on the claim, or the HCPCS code(s) connected to the supplies are not clearly noted on the invoice, the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider.
  • The units billed for the revenue code 278 must match the units on the vendor’s invoice(s) – these units must be clearly indicated on the vendor’s invoice(s) submitted with the claim. If the units on the invoice do not match what was billed under revenue code 278 on the claim, or are not clearly noted on the invoice, the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider. If supplies are purchased by the provider in bulk, the units that apply to the corresponding detail line billed with revenue code 278 on the claim billed must be noted on the invoice or the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider.
  • If vendor invoices support the payment of the revenue code 278, claims will be reimbursed at invoice price plus 20 percent.
  • Hospitals reimbursed on a cost to charge ratio, must submit vendor invoices with the initial submission of the revenue code 278. Without vendor invoices the revenue code 278 will be denied as a contractual obligation to the provider.
  • Charges billed under $15,000.00 for revenue code 278 will be audited randomly on post payment review.

Outpatient Hospital Claims

  • This policy applies to all hospitals reimbursed on a cost-to-charge ratio for outpatient services.
  • Billed charges over $3,000.00 for revenue code 278 will require a vendor’s invoice to support supplies used that correspond to the services rendered.
  • The HCPCS code associated with each detail line billed with revenue code 278 must be clearly illustrated on the vendor’s invoice(s) submitted with the claim. If the supplies on the invoice do not match the HCPCS billed under revenue code 278 on the claim, or the HCPCS code(s) connected to the supplies are not clearly noted on the invoice, the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider.
  • The units billed for the revenue code 278 must match the units on the vendor’s invoice(s) – these units must be clearly indicated on the vendor’s invoice(s) submitted with the claim. If the units on the invoice do not match what was billed under revenue code 278 on the claim, or are not clearly noted on the invoice, the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider. If supplies are purchased by the provider in bulk, the units that apply to the corresponding detail line billed with revenue code 278 on the claim billed must be noted on the invoice or the corresponding detail line with revenue code 278 will be denied as a contractual obligation to the provider.
  • If vendor invoices support the payment of the revenue code 278, claims will be reimbursed at invoice price plus 20 percent.
  • If no HCPCS code is appended to revenue code 278, it will be denied as a contractual obligation to the provider.

Posted 4-7-2017

Attention all Durable Medical Equipment (DME) Providers: The Electronic DME Service Authorization (SA) attachment option is now available. This option allows providers to electronically attach any files that contain required supporting documents for the DME SA. For example, doctor visit notes, sleep study, prescriptions, certificates of medical necessity (CMN), audiogram, etc. Using the electronically attaching option replaces the need to fax documents to the Department.

A provider instruction handout is available on the DME website to assist with step-by-step instructions on how to electronically submit the required supporting documents.

Posted 3-24-2017

A new coding guideline for Vaccines/Toxoids is now available.

Posted 3-7-2017

Attention all Dental Providers: A revised dental policy has been published for CDT Code D9410 – House/Extended Care Facility Call. This revised dental policy is effective 04/01/2017.

Posted 1-5-2017

ER Copayment and PT, OT and Speech Limits - Effective for dates of service on or after January 1, 2017, there is no longer a Medicaid copayment for non-emergent use of the Emergency Department. The previous copayment was $3.00.

Also, effective for dates of service on or after January 1, 2017, there will be no service limits on physical, occupational and speech therapy visits and evaluations for Medicaid recipients under the age of 21. All services submitted to ND Medicaid for payment must continue to be supported by medical records and documentation of medical necessity.

The Department initiated the necessary North Dakota Administrative Code and MMIS updates for both of these changes.

Posted 1-4-2017

Attention all DME Enrolled Providers - The following added/deleted HCPC codes and narrative changes to HCPC codes are effective for dates of service on or after Jan. 1, 2017.

The following HCPC codes have been deleted from the provider price file.

B9000
K0901

K0902

The following HCPC codes have been added to the provider price file.

A4224
A4225

Narrative changes have been made to the following codes.

B9002
E0627
E0629
E0967
E0995
E2206
E2220
E2221
E2222
K0045
K0019
K0037
K0042
K0043
K0044
K0069
K0046
K0047
K0050
K0051
K0052
L1906
K0071
K0072
K0077
K0098
K0552

More detailed information on these changes can be found in the 2017 Narrative Changes Summary.


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