*Medicaid*Medicare **Billing* Sharon Trivette Local Health Operations Branch

Craig Cooper, Branch Manager –Barbara Wiesenhahn –Mary Mullins –Kim True –Tammy Page –Anne Parr –Sharon Trivette –Cynthia Robinson –Cecilia Van Dyke –Nellie Ramsey –Janet Overstreet

What issues do I send to the Help Desk? Security for PSRS/Portal Security for PSRS/Portal Coding Issues Coding Issues Other Bridge (GUI) issues such as PEF entry Other Bridge (GUI) issues such as PEF entry All Medicaid, Medicare, Passport & Insurance problems All Medicaid, Medicare, Passport & Insurance problems Give brief description of problem in the subject line of your Give brief description of problem in the subject line of your

QUICK REFERENCE LIST DEPARTMENTSPHONE NUMBERSWEB ADDRESS (or ) Local Health Help Desk option help desk issues Local Health Operations option #5http://chfs.ky.gov/dph/info/lhd/lhob.htmLHO reference, forms, documents Local Health Personnel option #1 Local Health Personnel issues KyHealth Net Eligibility, claim Status, RA's HP EDI with Health Net, pin numbers HP Provider Billing claim inquiry/questions DMS Provider Enrollment http://chfs.ky.gov/dms/provEnr/Medicaid enrollment forms, reference DMS Member Services www.chfs.ky.gov/dmsEligibility, program codes DMS Fraud & Abuse To report fraud and abuse of Medicaid Passport http:// provider/claim inquiry NGS Medicare NPI Registry for NPI numbers CMS website

*MEDICAID*

Reminders Check eligibility every VISIT. Check eligibility every VISIT. School site eligibility denials should be worked and re-checked for eligibility frequently. Don’t write them off too soon! School site eligibility denials should be worked and re-checked for eligibility frequently. Don’t write them off too soon!

KY HEALTHNET ACCESS DPH has completed the implementation of the electronic Medicaid remittances via KyHealthnet. DPH has completed the implementation of the electronic Medicaid remittances via KyHealthnet. EVERYONE should have Pin #s now to access their RA’s. EVERYONE should have Pin #s now to access their RA’s. –You now have access to check claim status –HANDS program is next….

How do I get larger print on my RA’s?

Health Risk Assessment HRA is still under negotiation between DPH and Medicaid HRA is still under negotiation between DPH and Medicaid.

25 Modifier Still under negotiation with Medicaid. Still under negotiation with Medicaid. SIGNIFICANT, separately identifiable E&M service by the same provider on the same day. SIGNIFICANT, separately identifiable E&M service by the same provider on the same day. Documentation must clearly indicate and support the need for the separate service. Documentation must clearly indicate and support the need for the separate service.

E-Reports Reminder Please remember to check your 580 Cash Reject Report every week. Please remember to check your 580 Cash Reject Report every week. Work your 375 Applied/Pending Medicaid Report monthly. Work your 375 Applied/Pending Medicaid Report monthly.

Everything entered on PEF hits the 501 service file first. Then flags and payor code edits determine how and why a code bills to a particular payor. The Mdcd Bill flag sends they system to the 912 service file for Preventive.

For current Preventive Medicaid rate-always look at the 912 with provider class 10.

*MEDICARE*

Preventive Services Quick Reference Information Chart _PreventiveServices.asp#TopOfPage Quick Reference Information Chart _PreventiveServices.asp#TopOfPage _PreventiveServices.asp#TopOfPage _PreventiveServices.asp#TopOfPage Lists the covered Medicare Preventive Services, CPT codes, associated ICD-9s, eligible beneficiaries, and frequency rules. Lists the covered Medicare Preventive Services, CPT codes, associated ICD-9s, eligible beneficiaries, and frequency rules.

MNT and Medicare Every claim for MNT billed to Medicare must have a referring physician. Every claim for MNT billed to Medicare must have a referring physician. The referring physician must be registered in the Medicare PECOS system or the claim will deny. (effective 1/1/2011) The referring physician must be registered in the Medicare PECOS system or the claim will deny. (effective 1/1/2011)

Billing Medicare for MNT The referring physician’s name and NPI must be added to the PSRS before the MNT service can be billed. Please send this information to the Local Health Help Desk at The referring physician’s name and NPI must be added to the PSRS before the MNT service can be billed. Please send this information to the Local Health Help Desk at When entering MNT service on the PEF, the referring physician’s NPI must be entered into the override area of the PEF. The NPI # must be preceded by the letter “U.” IE: U When entering MNT service on the PEF, the referring physician’s NPI must be entered into the override area of the PEF. The NPI # must be preceded by the letter “U.” IE: U

Medicare Timely Filing CMS announced April 1 as part of The Patient Protection and Affordable Care Act. CMS announced April 1 as part of The Patient Protection and Affordable Care Act. reduction to 12 months from date of service to file Medicare claims. reduction to 12 months from date of service to file Medicare claims.

Big Changes Ahead….

ICD-10 CMS Final Rule requires conversion by 2013 CMS Final Rule requires conversion by 2013 Conversion to a new billing layout (4010 to 5010) by 1/1/2012. Conversion to a new billing layout (4010 to 5010) by 1/1/2012. DPH already working with Medicaid & CDP on the transition DPH already working with Medicaid & CDP on the transition

QUESTIONS?