• Quality Improvement across the Continuum: Reminder – registration closed June 8, 2016, for the home and community-based services providers and nursing facilities 2016 Long-Term Services and Supports conference on June 16, 2016. For conference details, review the Quality Improvement Across the Continuum web page.
Refer to the Provider Training page for information about new and ongoing training or to the list below for details on additional training sessions on special topics.
Announcements and availability: Watch the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.
Electronic Health Records (EHR)
CMS Hardship Exception Applications Due July 1, 2016
Submit hardship exception applications to the Centers for Medicare & Medicaid Services (CMS) by July 1, 2016, to avoid payment adjustments to Medicare reimbursement. Medicare eligible professionals, eligible hospitals, and critical access hospitals (CAH) that are not meaningful users of certified electronic health record (EHR) technology under the Medicare EHR Incentive program or Minnesota EHR incentive program are subject to a payment adjustment. If you are not a meaningful user, you may be eligible to apply for a CMS hardship exception.
Medicaid providers who are only eligible to participate in the Medicaid EHR incentive program are not subject to these payment adjustments. (Added 6/17/16)
CMS has corrected the 2016 Minnesota conversion factor amount from $21.50 to $21.13. MHCP identified and reprocessed claims for dates of service between January 1 and March 15, 2016. The reprocessed claims were on your May 3, 2016, remittance advice.
MHCP will reprocess IEP claims that were denied in error for age requirements for ICD-10 code F94.9. You will see the reprocessed claims on your May 17, 2016, remittance advice.
Outpatient hospital laboratory services: MHCP identified several outpatient laboratory services that were incorrectly priced from Jan. 1 through Apr. 29, 2016. These have been reprocessed and will be on the June 1, 2016, remittance advice.
This group of laboratory claims does not include the outpatient laboratory services assigned a status indicator Q4. We will reprocess the laboratory services claims with a Q4 indicator separately after the systems work is completed.
Center for Victims of Torture—Rate Negotiation for Targeted Case Management: The Center for Victims of Torture (CVT) cannot negotiate different rates for Mental Health Targeted Case Management (MH TCM) with different counties. County-negotiated rates cannot be more than the rate the provider charges for the same service to other payers. Before CVT provides services, they must receive agreement from the county that is financially responsible for the person receiving services. Refer to the Mental Health Update sent June 7, 2016.
Provider Travel Time: Follow these requirements to bill MHCP for mental health provider travel time:
• Document start and stop time of travel times to the minute for each service in each progress note
• Bill for the most direct route
• Enter the exact number of minutes of travel time in the units field on the claim
• Use the appropriate place of service code on the claim
• Bill travel time for only one member if the services are being delivered in a group format
• Document unusual travel conditions that may cause a need to bill for additional time
• Do not bill for detours for lunch breaks, nonmember service activities, or time for vehicle breakdowns
Members must have an individual treatment plan (ITP) specifying why the provider must travel to the member’s home, place of work, or other setting to provide services. Provider travel time covers only the time the provider is in transit to and from the member. Review the Mental Health Provider Travel Time section of the MHCP Provider Manual for more information.
Rate Increase to Mobile Crisis Services: Effective July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) approved the rate increases for mobile crisis response services. MHCP will replace claims for mobile crisis services with dates of service on or after July 1, 2015. We will post a message when we know the date the replacement claims will be on the remittance advice.
Crisis providers who have billed at the published fee-for-service rate will not see an increase to adjusted claims. Claims billed for more than the allowable amount will receive the increased rate. MHCP pays claims at the lesser of the provider’s submitted charge or the MHCP allowable payment rate. Continue to bill the usual and customary charge that applies on the date you provide the service, according to Minnesota Rules 9505.0450.
Diagnostic assessment rate correction: MHCP has updated its system to reflect a rate change effective January 1, 2016. We will replace claims with procedure code 90791 or 90792 and modifier TS or TG to pay at the correct reimbursement rate for dates of service starting January 1, 2016. The adjusted claims are on the May 17, 2016, remittance advice.
We will update the system and adjust claims at a later date for procedure 90791 and 90792 with modifier 52. These adjusted claims will be on your May 31, 2016, remittance advice. Refer to the Diagnostic Assessment section of the MHCP Provider Manual for CPT codes and information.
Public Health Nursing Clinic Services
Effective for dates of service on and after June 1, 2016, MHCP made changes to the rate and allowable units for public health nursing home visits reported with code S9123. This change brought MHCP into compliance with national and state reporting requirements. However, we recognize concerns within the stakeholder community and will implement this change as follows:
1. For dates of service June 1, 2016, through July 31, 2016, the base rate will remain $61.73 per unit. The unit designation for S9123 is one unit per hour, with a maximum of one unit per day. We will revise the Clinic Services section of the MHCP Provider Manual and the MHCP Fee Schedule to reflect this.
2. MHCP will work with stakeholders to determine if any additional changes should be considered for dates of service on and after August 1, 2016. We will communicate this information through our Provider News before the change is effective.
MHCP covers G0279 for Digital Breast Tomosynthesis (3-D Mammogram) as of February 1, 2016. G0279 is only covered when billed in conjunction with either G0204 or G0206. MHCP will reprocess any denied claims for dates of service on or after February 1, 2016. (Added 6/21/16)
End Stage Renal Dialysis (ESRD) Medicare Claims: MHCP identified a system error with ESRD Medicare services. When the patient’s responsibility is zero, the system was applying a spenddown. Affected claims were processed from June 2013 through June 15, 2016. We will reprocess these claims over the next two warrant cycles.
If a spenddown was applied in error, an overpayment may have occurred. MHCP will recoup these overpayments when we correct the claim. You will see the recoupments on your remittance advice. If an ESRD center collected the spenddown amount from the recipient, you must refund the recipient or the recipient’s family. (Added 6/20/16)
Restriction on adding or changing service agreements: The Minnesota Legislature authorized the following rate and limit changes for services provided on or after July 1, 2016:
• 0.2 percent rate increase for Consumer Directed Community Supports (CDCS), Consumer Support Grant (CSG) and personal care assistance services (PCA)
• 21.3 percent increase to Elderly Waiver (EW) and Alternative Care (AC) individual case-mix budget caps, Elderly Waiver customized living and 24-hour customized living service limits, and CDCS monthly case-mix limits in EW and AC
• Transition to daily rate for EW customized living services and adult foster care
DHS will run an MMIS automation process on June 13, 2016, for rate changes on Service Agreements (SAs). Lead agency (county and tribal) staff will be unable to add or make changes to some SAs from June 9 to June 14, 2016, while we update the system for this change. This does not affect ADAD and homecare SAs. DHS will notify lead agencies when they are again able to update SAs.
Training and VideoPresence Opportunities
Information about most new and ongoing training is on the Provider Training page. Any information listed in this section is for additional training sessions on special topics.