Provider Update Newsletter
October 2000, Volume 96
All Providers
DHS Website
HIPAA Happenings
REVS Update-QMB Code Changes
EFT- Electronic Funds Transfer
Electronic Billing Saves Time and Money
Home Health Providers
New Home Health Base Rates
HCFA, Outpatient and Nursing Home Care Providers
Flu and Pneumonia Season is here!
DME Providers
DME Obsolete Codes
DHS Website
We've made updates to our website. And, during the months of September
and October, we expect to transition the site to a new location (same address
though) where we’ll be able to provide even better service. We will be looking
at the possibility of being able to offer more information and better responses
to FAQ’s and forms (possibly even claims submission) through the Web over
the next several months. Please forward any comments, concerns or questions
to the Webmaster at the site.
HIPAA Happenings
As you’re probably aware, Final Rules for the new HIPAA Transaction Sets
were published in the Federal Register on August 17, 2000. The countdown to
implementation has begun (October 2002) and DHS and EDS are committed to
compliance before the deadline.
Over the course of the next two years, we will hold information and training
sessions as new policies and procedures are developed in order to continue
providing seamless delivery of services and payments to our client and provider
populations.In addition, we strongly encourage you to visit the sites below,
particularly the HCFA and Washington Publishing Company sites in order to
stay up-to-date with HIPAA activities.
As you begin you evaluation of the changes that will be required to implement
HIPAA Administrative Simplification requirements, we suggest that you be
cautious of companies who are touting "HIPAA-compliant" products. To date,
the only Final Rules published relate to Claims Transaction Sets. To view
proposed regulations relating to security, confidentiality and privacy, please
visit the HCFA HIPAA site.
www.hcfa.gov/hipaa/hipaahm.htm
– HCFA's HIPAA page
www.wpc-edi.com– Washington Publishing
Company; the manuals and
implementation guides for new transaction sets
www.ehnac.org– Electronic Healthcare Network
Accreditation Commission
www.ps-tag.org– Private Sector Technical
Assistance Group; white papers on
HIPAA financial considerations
www.rx2000@rx2000.org– listserv group
featuring daily discussions about
HIPAA policy and implementation.
www.disa.org– Data Interchange Standards
Association; HIPAA page
www.wedi.org– Workgroup for Electronic Data
Interchange; HIPAA page
http://aspe.os.dhhs.gov/admnsimp/faqtx.htm–
US Department of Health and
Human Services Web site; frequently asked questions concerning HIPAA
standards and implementation
REVS Update-QMB Code Changes
The REVS line has been updated to include new information for Qualified
Medicare Beneficiaries (QMB). When calling to request eligibility segments
for recipients that have a QMB Aid Category code, the REVS line will respond
with the following information:
"Recipient number 123 45 6789 is a Qualified Medicare Beneficiary
and eligible only for reimbursement of certain Medicare Crossover Claims from
MM/DD/YY to MM/DD/YY."
EFT- Electronic Funds Transfer
EXPEDITES ACCESS TO CASH BY 3-7 DAYS!
DEPOSITS ARE MADE THE DAY THE PAPER CHECKS ARE MAILED!
TIMELY AND COST EFFECTIVE!
If you are interested, please complete the Authorization for Direct Deposit form
on the provider form page and return to:
EDS
PO Box 2010
Warwick RI 02887-0210
Attn: Financial Department
Electronic Billing Saves Time and
Money
Electronic Media Claims (EMC) is the fastest, most convenient and
accurate
way to submit your Medical Assistance claims to EDS. Submitting your claims
electronically saves time, reduces clerical effort, eliminates mailing and paper
costs and minimizes billing errors. EDS offers FREE billing software or we can
work with your MIS department, vendor, billing agent or clearing house to get
you started with EMC. For more information or to enroll for electronic billing,
contact the EDS Customer Service Help Desk at (401) 784-8100 for local
and long distance callers, or 1-800-964-6211 for instate toll calls and
border communities.
New Home Health Base Rates
Below is a list of new base Home Health Rates Effective July 1, 2000
PROCEDURE CODE |
DESCRIPTION |
NEW BASE RATE EFFECTIVE
7/1/2000 |
I2100 |
HOMEMAKER ONLY - NON-WAIVER (1 HOUR) |
$13.56 |
W1100 |
HOMEMAKER ONLY - MR/DD WAIVER ( 1 HOUR) |
$13.56 |
W2100 |
HOMEMAKER ONLY - AGED AND DISABLED (AD) WAIVER (1
HOUR) |
$13.56 |
| |
|
|
I2101 |
HOMEMAKER ONLY - 1/2 HOUR, NON-WAIVER |
$6.78 |
W1101 |
HOMEMAKER ONLY - MR/DD WAIVER (1/2 HOUR) |
$6.78 |
W2101 |
HOMEMAKER ONLY-AGED AND DISABLED (AD) WAIVER (1/2
HOUR) |
$6.78 |
W5101 |
HOMEMAKER ONLY - DEPARTMENT OF ELDERLY AFFAIRS
(DEA) WAIVER (1/2 HOUR) |
$6.78 |
| |
|
|
I2200 |
PERSONAL CARE ONLY - AD WAIVER (1 HOUR) |
$14.45 |
W1200 |
PERSONAL CARE ONLY - MR/DD WAIVER (1 HOUR) |
$14.45 |
W2200 |
PERSONAL CARE ONLY - AD WAIVER (1 HOUR ) |
$14.45 |
X0041 |
HOME HEALTH AIDE, FIRST HOUR |
$14.45 |
X0087 |
PERSONAL CARE – EPSDT (1 HOUR ) |
$14.45 |
| |
|
|
I2201 |
PERSONAL CARE ATTENDANT- NON-WAIVER (1/2 HOUR) |
$7.23 |
W1201 |
PERSONAL CARE AID ONLY MR/DD WAIVER (1/2 HOUR |
$7.23 |
W2201 |
PERSONAL CARE ONLY - AD WAIVER (1/2 HOUR) |
$7.23 |
W5201 |
PERSONAL CARE ONLY - DEA WAIVER (1/2 HOUR) |
$7.23 |
X0044 |
HOME HEALTH AIDE, (1/2 HOUR) |
$7.23 |
X0089 |
PERSONAL CARE – EPSDT (1/2 HOUR) |
$7.23 |
| |
|
|
I2300 |
COMBINED HOMEMAKER/PCA- NON-WAIVER (1 HOUR) |
$13.94 |
W1300 |
COMBINED HOMEMAKER AND PERSONAL CARE - MR/DD
WAIVER (1 HOUR) |
$13.94 |
W2300 |
COMBINED HOMEMAKER AND PERSONAL CARE - AD WAIVER
(1 HOUR) |
$13.94 |
| |
|
|
I2301 |
COMBINED HOMEMAKER/PCA - NON-WAIVER (1/2 HOUR) |
$6.97 |
W1301 |
COMBINED HOMEMAKER AND PERSONAL CARE-MR/DD WAIVER
(1/2 HOUR) |
$6.97 |
W2301 |
COMBINED HOMEMAKER AND PERSONAL CARE - AD WAIVER
(1/2 HOUR) |
$6.97 |
W5301 |
COMBINED HOMEMAKER AND PERSONAL CARE - DEA WAIVER
(1/2 HOUR) |
$6.97 |
Flu and Pneumonia Season is here!
The Department of Human Services will reimburse for the influenza and
pneumonia vaccines for "Fee for Service" Medicaid recipients
(21 years of age and older). For recipients under 21, follow the policy outlined
in the Physician Manual on page 300-05-17.
PHYSICIAN AND OUTPATIENT SERVICES
Pneumonia and Influenza Immunizations/Age 21 and over
Effective immediately, the Department of Human Services will begin reimbursing
for the Pneumonia and Influenza vaccines for fee-for-service recipients age
21 and over.
A. When the vaccine is administered during an office visit, the serum can be billed
along with the office visit. The administration of the vaccine, however, is included
in the office visit and cannot be billed separately.
Examples
Office Visit
99213,
etc.
office
visit charge
Influenza Vaccine
90658,
90659 $3.49
Office visit
99213, etc
office
visit charge
Pneumonia Vaccine
90732
$11.74
B. If the recipient is only receiving the vaccine, without an office visit, both
the
vaccine and the administration can be billed. When billing for the vaccine, please
remember to include the proper place of service as referenced in your provider
manual. If the place of service is not listed (i.e. housing authority), please use 99.
Examples
Influenza Vaccine
90658, 90659
$3.49
Administration of Influenza Vaccine G0008
$4.71
Pneumonia Vaccine
90732
$11.74
Administration of Pneumonia Vaccine G0009
$4.71
- When the vaccine is administered during an office visit, the serum can be
billed in addition to the office visit. The administration of the vaccine,
however, is included in the office visit and cannot be billed separately.
- When the recipient receives the vaccine without an office visit, such as at a
"Flu and Pneumonia Immunization Clinic" both the vaccine and the
administration code can be billed. Claims must be individualized by recipient and include
the proper place of service. If the place of service is not referenced in your Provider
Manual (i.e.: housing authority) please use
POS 99.
- DHS will reimburse a Home Nursing Care Provider for a skilled visit to
administer the vaccine to Medicaid recipients in their home when medically
necessary. The serum can be billed in addition to the skilled nursing visit, but
administration of the vaccine cannot be billed separately.
DME Obsolete Codes
XX codes (nutrition) have been made obsolete effective 10/1/1999. Please use
B codes in place of XX codes. Active PA's for the XX codes will be converted
over to B codes were applicable according to dates of service.
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