RHC Clinical Quality Meeting February 8, 2018

Agenda Review of MSA 17-10 Procedure Code T1015 Medicaid Primary Reporting Medicaid Secondary Claims Reporting to the Managed Care Plans System Fixes/System Defects Provider Resources

MSA 17-10 (Revised MSA 17-24) Institutional Clinic Billing

MSA 17-10 (Revised MSA 17-24) MSA 17-24 was issued pushing back the implementation of 17-10 to August 1, 2017 MSA 17-24 also made clarification that the MIHP and MICare programs are not effected by MSA 17-10 All services rendered in the RHC clinic must be billed on the UB to receive proper claim adjudication. T1015 is to be used by RHC’s only as the Visit Code where reimbursement will be made

Procedure Code T1015 Institutional Clinic Billing

Procedure Code T1015 T1015 is to be used by all RHC provider in order to receive proper reimbursement The proper revenue codes must be illustrated along with the Visit Code and Qualifying Visit Codes When claim reimbursement is made the PPS rate will only be reimbursed on the T1015, with the Qualifying Visits paying at $0.00

Medicaid Primary Reporting Institutional Clinic Billing

Medicaid Primary Reporting There are 3 ways that the T1015 can be reported on a Medicaid Primary claim Which ever way the T1015 is reported the reimbursement on the claim will only be paid on the T1015, resulting in the qualifying visit paying at $0.00 T1015 can be reported at $0.00 with the cost reported at the qualifying visit line T1015 can be reported with all cost associated to the qualifying visit lines rolled up. T1015 can be reported with $0.01, to follow Medicare

Medicaid Secondary Reporting When reporting the T1015 on a Medicaid secondary claims it will more then likely be reported 1 of 2 ways T1015 can be reported at $0.00-this is how Medicare wants the T1015 reported and will allow for a proper Medicare crossover T1015 can be reported at $0.00, if the T1015 needs to be added to a commercial insurance primary claim.

Reporting T1015 to the Managed Care Plans T1015 is required to be reported to the HMO’s as well. T1015 should only be reported on those claims that count as an encounter. We have heard that some HMO’s are requiring the T1015 even on claims that are not encounters. We are working with the HMO’s to get this straitened out. The HMO’s are not paying the PPS Rate but instead they are paying either: The FFS fee screen rates Suggested Managed Care rates Rate within the contract between the HMO and the clinic

System Fixes/System Defects Institutional Clinic Billing

Provider Resources MDHHS website: www.michigan.gov/medicaidproviders We continue to update our Provider Resources, just click on the links below: Listserv Instructions Medicaid Alerts and Biller “B” Aware Quick Reference Guides Update Other Insurance NOW! Medicaid Provider Training Sessions Provider Support: ProviderSupport@michigan.gov or 1-800-292-2550 Thank you for participating in the Michigan Medicaid Program