Provider Update Newsletter
December 2002, Volume 122
All Providers
HIPAA Happenings
HIPAA Privacy
Changes in Home Based Therapeutic Services
LTC Providers
Important dates for Provider Electronics Solution
Software
Nursing Home/Hospice Care Providers
Home Health Providers
Billing Guidelines
Physician Providers
Advise on Office Visit Codes
DME Providers
Billing for Blood Glucose Test Strips and Supplies
HIPAA Happenings
Local Procedure Code Mapping to National Procedures Code
HIPAA mandates that all states eliminate the use of their local procedure codes except as specifically provided within 42 CFR. The purpose of local procedure code mapping is to attempt to crosswalk the RI local codes to any existing or new National HCPCS, CPT, ADA or other National Code Sets. This crosswalk effort will also include research of NMEH submissions of Pended and Approved codes. For those codes, which are currently ‘Pended’, EDS and DHS will crosswalk to the placeholder code until approved.
Upon the outcome of this effort, EDS and DHS will have concluded what direction the current local procedure codes will have taken. This would include, but is not limited to a one to one crosswalk to a National Code, a one to many crosswalk to a National Code with the use of modifiers, elimination of the local procedure code without a crosswalk due to the lack of necessity for the code, a non covered code, an Obsolete code, non-medical service code, etc.
It should also be noted that as well as state assigned local procedure codes; HIPAA mandates that all states eliminate the use of state specific diagnosis codes, revenue codes and modifiers. EDS and DHS will also collaborate on the mapping of these local codes
HIPAA Privacy
What: You are invited to a workshop: HIPAA Privacy Regulations Awareness Training
Why: HHS Secretary Tommy G. Thompson recently issued the first – ever comprehensive federal regulation that gives patients sweeping protections over the privacy of their medical records. The final regulation, which takes effect April 14,2003, will ensure strong privacy protection without interfering with American’s access to quality healthcare. The workshop will help with identifying your needs. Has your organization appointed a Privacy Officer? Are your procedures developed for new policy needs required by HIPAA?
When: Friday, December 13,2002, 9:00AM – 12:00PM
Where: State Facility Medical Center Complex,
Eleanor Slater Hospital,
The Reagan Building,
Arnold Conference Center,
111 Howard Avenue, Cranston RI
How do I sign up: Contact Dorothy Pizzarelli,
EDS Provider Services, at 401-784-3849
Changes in Home Based Therapeutic Services
Program
The Center for Child and Family Health at the Department of Human Services issued certification standards for its Home Based Therapeutic Services Program (HBTS) in August, 2002.
All existing providers must be certified by April 1, 2003 in order for the agency to be reimbursed for services provided after that date. Applications for certification must be submitted to DHS. Send to the attention of:
Ann Roach: Center for Children and Families
600 New London Ave.
Cranston, RI 02920
by January 15, 2003 in order for an agency to be certified by April 1st. The HBTS certification standards are available on the DHS website – www.dhs.state.ri.us.us. From the home page, under services for children and families, click children with special needs, then scroll down to Home Based Therapeutic Services.
Effective January 1, 2003 all HBTS services will be reimbursed under a fee for service reimbursement methods. Providers will be trained in the new reimbursement methods in early December, 2002. All HBTS providers will also be required to re-enroll with EDS as a HBTS provider as a new provider type established for this program.
If you require additional assistance or have further questions, contact Karen Richard at EDS 401-784-3888.
Important Dates for Provider Electronics
Solution Software
If you are using the Provider Electronic Solution software please note the following dates:
|
Month |
TAD's Due
Paper Claims |
Nursing Home
EMC Claims Due
by 12:00 Noon |
Cycle Date |
EDS Wire
Transfer |
| January |
01/06/03 |
01/09/03 |
01/11/03 |
01/17/03 |
| February |
02/05/03 |
02/06/03 |
02/08/03 |
02/14/03 |
| March |
03/05/03 |
03/06/03 |
03/08/03 |
03/14/03 |
| April |
04/07/03 |
04/10/03 |
04/12/03 |
04/18/03 |
| May |
05/05/03 |
05/08/03 |
05/10/03 |
05/16/03 |
| June |
06/04/03 |
06/05/03 |
06/07/03 |
06/13/03 |
Billing Guidelines
If you are billing procedure code W1400 – Homemaker LPN MR/DD Waiver, the following procedures apply for billing:
Submit the prior authorization request along with the HS3 form that is sent to you from the Department of Mental Health Retardation and Hospitals Division of Developmental Disabilities. Not attaching the HS3 will delay a authorization for prior approval.
W1400 – HOME MAKER LPN, MR/DD, new rate increase effective 7/01/02 – $31.06
X0043 – Home Health Nursing and Therapy Visit, new rate increase effective 7/1/02 – $65.73
X0088 – Skilled Pediatric Nursing Service, provided by an RN, new rate increase effective 7/1/02
|
RN |
LPN |
| DS |
$33.92 |
DL |
$31.80 |
| ES |
$36.03 |
EL |
$33.92 |
| NS |
$39.22 |
NL |
$34.98 |
| WS |
$39.22 |
WL |
$34.98 |
| HS |
$52.99 |
HL |
$47.69 |
Adult Day Care Rate Increase
X0331 – Adult Day Care, new rate increase effective 7/1/02 – $37.11
EPSDT Personal Care Code
X0089 – Personal Care Per ˝ hour, units have been increased to 16 to allow billing for an 8-hour day at the half hour code.
Nursing Home/Hospice Care Providers
When a recipient is in a Long-Term Care facility and receiving services from a Hospice agency, the recipient status should be listed as an “05” (discharged to Hospice) on the monthly long-term care claim. During the period the patient is receiving Hospice care and residing in the Nursing Home, Rhode Island Medicaid should NOT be billed by Long-Term Care facilities. The Nursing Home should bill the Hospice provider and the Hospice provider is eligible for billing Rhode Island Medical Assistance. Should you have further questions, please contact Dana Ciampanelli at 401-784-3889
Advice on Office Visit Codes
When billing an office visit for a new patient here are some points to keep in mind:
Code 99201 --Visit is problem focused noting a chief complaint and a brief history of
the illness or problem. The examination is problem focused and
decision-making is straightforward. Presenting problems are minor or
self - limiting. Physician time spent with patient is about 10 minutes.
Code 99202 --Visit is expanded in problem focus noting the chief complaint, a brief
history of illness and pertinent system review. Exam is also problem
focused and again has straightforward decision-making. Presenting
problems are low to moderate in severity. Physician time spent with
patient is about 20 minutes.
Code 99203 -- Visit has a detailed history noting the chief complaint, extended history
of the illness with a problem pertinent system review extending to a
limited number of other systems. Pertinent past, family and social
history directly related to problem is also recorded. A detailed
examination is done and medical decision-making is of low complexity.
Presenting problems are moderate in severity. Physician time spent
with patient is about 30 minutes.
Code 99204 -- Visit has a comprehensive history noting chief complaint, extended
history of present illness; review of systems directly related to
identified problems in past plus a review of all body systems. A
comprehensive examination is done and medical decision making is of
moderate complexity. Presenting problems are of moderate to high
severity. Physician time spent with patient is about 45 minutes.
Code 99205 --Visit has a comprehensive history noting chief complaint, extended
history of present illness; review of systems directly related to identified
problems in past plus a review of all body systems. A comprehensive
examination is done and medical decision-making is of high
complexity. Presenting problems are of moderate to high severity.
Physician time spent with patient is about 60 minutes.
For a more detailed explanation of these codes please refer to the 2003 Physicians’ Current Procedural Terminology Manual. (CPT Manual)
Billing for Blood Glucose Test Strips and Supplies
According to Medicare Policy, 61.1.2, Billing for Blood Glucose Test
Strips and Supplies (p.4),
effective April 1, 2002, suppliers must file claims for blood glucose
supplies and test strips on
on behalf of the beneficiary for dates of services on of after October
1, 2001. Medicare will no
longer claims filed by the beneficiary. Suppliers must complete the
"from" and "to" dates in Block 24
of the HCFA-1500 form when filing claims for blood glucose supplies
(codes A4253, A4255,
A4256 AND A4259). The "from" and "to" dates of
service cannot be exact duplicates. As of October 23, 2002 The RI
Medical Assistance MMIS has been updated in order to accommodate
Medicare's policy change regarding this issue. Therefore, claims
electronically crossing from Medicare to
Medicaid will no longer automatically deny and providers will no longer
need to resubmit these claims on paper.
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