Presentation is loading. Please wait.

Presentation is loading. Please wait.

2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara.

Similar presentations


Presentation on theme: "2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara."— Presentation transcript:

1 2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara Rogers – Facilities Manager Brenda Stout – Behavioral Health Manager

2 Session Topics: Introductions Medicaid Decision Making WY Medicaid ICD-10 Project Upcoming Program Changes – Chiropractic – Mental Health Provisional Providers 2

3 Program Managers Amy Buxton – Ambulance, DME, Hearing and Audiology, Lab and Radiology, PT/OT/ST, Client Transportation Sheree Nall – Physician and Nurse Practitioner Services, Indian Health Services, ASC, Health Homes, Family Planning Waiver, Public Health Nurses Sara Rogers – Hospitals, ESRD, Nursing Home, RHC/FQHC, PRTF, CORF Brenda Stout – CMHC/SATC and Mental Health Services 3

4 Medicaid Decision Making Process Code of Federal Regulations (CFR) – Title 42 – Public Health – http://www.ecfr.gov/cgi-bin/ECFR?page=browse http://www.ecfr.gov/cgi-bin/ECFR?page=browse Wyoming State Statutes – Title 42 – Welfare – Wyoming Medical Assistance and Services Act – http://legisweb.state.wy.us/statutes/statutes.aspx http://legisweb.state.wy.us/statutes/statutes.aspx 4

5 Wyoming State Rules – Agency: Health, Department of – Program: Medicaid – http://soswy.state.wy.us/rules/ http://soswy.state.wy.us/rules/ Wyoming Medicaid State Plan – Approved by Centers for Medicare/Medicaid Services (CMS) – http://legisweb.state.wy.us/statutes/statutes.aspx http://legisweb.state.wy.us/statutes/statutes.aspx 5

6 Wyoming State Legislature – Statutes and Budget Governor - Statutes and Budget Wyoming Medicaid, Division of Healthcare Financing – State Medicaid Agent – Provider Operations Administrator – Program Manager 6

7 ICD-10 – Coding Specificity – All required digits must be present – Review ICD-10-CM book for required digits – Claims will deny if codes are not complete – Unspecified codes will not be accepted 7

8 Systems & Interface Testing Testing – Provider end-to-end testing is in progress – register at www.wyomingicd10.com www.wyomingicd10.com – Providers will be able to test specific clinical scenarios to evaluate coder competency and/or evaluate claim processing and denial rates for batches of test files submitted – MUST REGISTER TO TEST – all providers are encouraged to register for testing 8

9 Why Test? Avoid payment and cash flow interruption Ensure revenue neutrality – specifically hospital and inpatient level of care payments Ensure billing process readiness and system capability for interfacing and transmitting ICD-10 claims to Wyoming Medicaid: YOUR BILLING SYSTEM MAY NEED UPGRADES OR ADDITIONAL CONFIGURATION EVEN IF YOUR BILLING STAFF IS PREPARED! At the conclusion of testing, providers will be provided with a summary of testing action, denial/paid rates, edits that posted and payment variances detected. 9 WHY TEST?

10 Billing after 10/1/2015 will be date of service (DOS) driven: DOS prior to 10/1/2015 MUST be billed with an ICD-9 diagnosis/surgical procedure code. DOS 10/1/2015 and after MUST be billed with an ICD-10 diagnosis/surgical procedure code. Inpatient services that span September 2015 – October 2015 MUST have ICD-10 coding requirements, as the “through” DOS will determine coding requirements. 10

11 New Programs and Program Changes Chiropractic Mental Health Provisional Providers 11


Download ppt "2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara."

Similar presentations


Ads by Google