MHCP Provider News

April 7, 2014 News


  • • Review the Letter to the MN Court Systems, MN County Attorneys, County Directors, Case Managers and Tribal Agencies for information about the comprehensive plan of action related to the Jensen Settlement Agreement (Federal Court Civil File No.09-1775 (DWF-FLN)). (Added 4/15/14)
  • • DHS is contracting with Vital Research to conduct in-person interviews with people who receive long-term services and supports or who are appointed as a guardian for someone who receives these services. We expect the Adult Consumer Survey and the National Core Indicators Survey projects to begin in early spring 2014 and end in early summer. Refer to the DSD E-List Announcement if you have questions or are contacted for the survey and want more information.
  • • We previously announced that we would reduce claims by 2% as a result of federal spending cuts known as sequestration. On further review of the federal sequestration cuts that apply to Medicare payments and the impact on MHCP fee-for-service (FFS) rates, we determined that no MHCP payments for services are required to be reduced by 2% as a result of sequestration. We will begin reprocessing those claims that were reduced to reinstate the 2% as soon as we complete the necessary programming.
  • • Review recent Provider Updates:

  • MN–ITS

    On March 6, 2014, the following functionality changes were made to MN–ITS:

  • • When copying, replacing or voiding a claim, Edit buttons appear for all screens in the Application Progress feature. However, the claim can be validated or submitted only when all required fields are completed
  • • Only billing intermediaries, such as clearinghouses, are able to change the pay-to-provider field on a Request Status (276) transaction. All other providers must search for claims by the NPI they used to log in to MN–ITS
  • • We removed the Certification Condition Indicator field from the Situational Services section of the 837P Services screen. MHCP did not use this field
  • • Descriptive text is included in the drop down fields for Fixed Form Qualifiers on the 837P and Admission Source on the 837I to identify the code descriptions
  • • On the 837I, the Admission Hour and Date fields must both be completed if either one is entered
  • • The Bill Type field on the 837I allows both alpha and numeric characters

  • Continue to refer to the 5010/D.0 Announcements page for additional information about MN–ITS functionality.

    Industry Initiatives

    This Industry Initiatives section is intended to give you quick, easy access to current federal and state industry initiatives that potentially impact your business. Please review these pages on a regular basis. We will note changes to the right of the initiative as we update the pages.

    5010/D.0

    Review the updated 5010/D.0 page for announcements about both direct data entry (DDE) and batch transactions.

    Behavioral health home

    Review the Behavioral health home page.

    Electronic health records

     

    e-Prescribing

     

    Integrated Health Partnerships demo

    HCDS has changed its name to Integrated Health Partnerships (IHP) demonstration with new contract awards for Hennepin Healthcare System, Inc. (Hennepin County Medical Center Hospital and Clinics), Mayo Clinic, and Southern Prairie Community Care (SPCC) beginning in 2014. Along with six providers already participating in the demonstration, the additions increase its scope to 145,000 Medical Assistance enrollees. IHP demonstration strives to deliver higher quality and lower costs through innovative approaches to care and payment. Through this demonstration, Minnesota is one of a growing number of states to implement an Accountable Care Organization model in its Medicaid program, with the goal of improving care for enrollees.

    Health care homes

    Refer to the Health Care Homes Eligible Providers section in the MHCP Provider Manual about notifying MHCP of your HCH certification.

    ICD-10

    The U.S. House and Senate passed HR 4302 on March 31, 2014. The bill was enacted into law on April 1. This bill delays implementation of ICD-10 until at least October 1, 2015. The Centers for Medicare & Medicaid Services (CMS) will provide more direction, including an implementation date, and MHCP will provide information as it is available. Continue to refer to the ICD-10 page frequently for updates.

    NCCI

    The Centers for Medicare and Medicaid Services (CMS) is reinstating Procedure to Procedure (PTP) NCCI edits that pair immunization administration codes (CPT 90460-90474) with the preventive medicine Evaluation and Management (E/M) service codes (99381-99397) to be effective April 1, 2014. The edits apply to claims with dates of service on or after January 1, 2013, that are submitted on or after April 1, 2014. The edits may be bypassed if a PTP-associated modifier is correctly appended to the preventive medicine E/M code.

    Pay-for-performance

    Pay-for-Performance (P4P) program providers may earn up to two payments of $250 dollars in 12 months for providing optimal diabetes and cardiovascular disease care to eligible fee-for-service (FFS) recipients.

    Advanced Diagnostic Imaging Accreditation

    Effective for dates of service on or after August 1, 2013, providers billing the technical component (TC) of advanced diagnostic imaging (ADI) services must submit the Advanced Diagnostic Imaging Accreditation Requirements – Assurance Statement (DHS-3872) and a copy of their accreditation(s) to MHCP. The following provider organizations are excluded from this requirement:

  • • Inpatient and outpatient hospital providers
  • • Ambulatory surgical centers
  • • Provider-based clinics

  • Refer to the Radiology/Diagnostic Services section of the MHCP Provider Manual and MN Statute 144.1225 for additional information about the accreditation requirements. We also communicated the requirements in the MHCP Provider News for December 3 through December 31, 2013. This message was updated on Feb. 10, 2014.

    MHCP will begin reprocessing all claims for the TC of ADI services for dates of service on or after August 1, 2013, as soon as we complete the necessary system programming. Claims will be denied for providers who do not have the appropriate accreditation on file. To prevent claim denials, fax the required documents to 651-431-7616 from March 20, 2014, until April 28, 2014, only. Fax documents no later than April 28, 2014, or upon receipt of accreditation.

    CCDTF Rate Search

    (Added 4/11/14)

    Minnesota Health Care Programs (MHCP) is aware that the CCDTF rates search page in MN–ITS is not working. Technical staff is working on the problem. Please try again later or watch the MHCP Enrolled Providers – Alcohol and Drug Abuse Web page for information.

    Chemical Dependency Institution for Mental Disease (CD IMD)

    County and tribal workers are not able to change the eligibility code from MA to IM for recipients whose eligibility was approved through MNsure. This code must be changed before the service agreement (SA) can be approved. A work process has been put in place so SAs are able to be approved. This will not affect claims.

    Drug Testing

    Effective for dates of service on and after April 1, 2014, drug screening is considered medically indicated as described in Medicare Local Coverage Determination L28145. Report drug screening using codes G0434 or G0431 for each encounter; do not use codes 80100 or 80101. Confirmatory drug testing is considered medically indicated when the result of the drug screen is different from what is suggested by the medical history, clinical presentation or recipient report. Report confirmatory testing using code 80102 only.

    Refer to the MHCP Provider Manual Laboratory/Pathology Services section for more information.

    Hearing Aids

    MHCP removed the Phonak CROS models from the current Hearing Aid Volume Purchase Contract. The hearing aids billed with these CROS models are denying due to an NCCI edit. We will notify providers when the problem is resolved.

    Hospital Emergency Department (ED)

    MHCP reprocessed claims with codes 99281 or 99282 that had denial code N65 for dates of service on or after Jan. 1, 2014, adjudicated from Jan. 1, 2014, through Jan. 13, 2014. Refer to your March 11, 2014, warrant for the corrected claims. Claims adjudicated from Jan. 14, 2014, through Feb. 11, 2014, that had RARC denial code N65 are currently being reprocessed. Refer to your March 25, 2014, warrant for the corrected claims.

    Non-Emergency Services

    As of Jan. 1, 2014, hospital emergency departments must follow updated medical screening policies to redirect recipients who present with non-emergency conditions to an appropriate non-emergency service provider.

    Individualized Education Plan (IEP) Mental Health Spring Training

    The Individualized Education Plan (IEP) Mental Health Spring 2014 Training session scheduled for April 1, 2014, in Crookston, Minnesota has been cancelled. Refer to Provider Update IEP Mental Health Spring 2014 Training (IEP-14-01) for information and a link to available training sessions and locations.

    Inpatient Hospital Authorization

    Readmissions

    Review updated information in the MHCP Provider Manual for Readmission to Physical Rehabilitation and Long-Term Acute Care Facility (LTAC). If a recipient’s stay in an LTAC is interrupted by a brief (less than 15 days) admission to a short-term acute care hospital, the LTAC may file a claim for the first stay, and then request a second Inpatient Hospital Authorization (IHA) on the recipient’s readmission. The LTAC must provide the medical review agent with documentation the readmission is for the same reason as the initial admission. If it is not for the same reason or the recipient was in short-term acute care for 15 days or more, the return to the LTAC is considered a new admission and a full review is required for another IHA.

    Detoxification Guidelines

    Reminder: Inpatient Hospital Authorization is not required for adult admissions that are solely for detoxification. Refer to the MHCP Provider Manual section for Inpatient Hospitalization for Detoxification Guidelines.

    Mental Health

    (Added 4/14/14)

    The Mental Health Code and Rates chart has been updated for 2014. Use the chart for all services provided on dates of service on and after January 1, 2014.

    Mental Health – Psychotherapy and Prolonged Services

    Effective January 1, 2013, use the appropriate prolonged services code (99354) with 90837 to report psychotherapy face-to-face with the recipient of 90 minutes or longer. MHCP enrolled providers who are eligible to perform psychotherapy may bill prolonged services for this service. Refer to Psychotherapy in the Mental Health Services section of the MHCP Provider Manual for this information.

    Outpatient Hospital Laboratory Tests

    Effective for dates of service on or after January 1, 2014, most clinical diagnostic laboratory tests (excluding molecular pathology test) performed in an outpatient hospital setting billed on type of bill (TOB) 13X are packaged under the Outpatient Prospective Payment System (OPPS), instead of the Clinical Laboratory Fee Schedule (CLFS). Refer to the MHCP Fee Schedule and the Laboratory/Pathology Services section of the MHCP Provider Manual for more information.

    MHCP began processing these services reported on the 837I Institutional claim form using the OPPS on Jan. 27, 2014. MHCP identified and replaced claims with 2014 dates of service that were submitted before Jan. 27, 2014. The replacement claims for TOB 13X were on the remittance advice for payment date Feb. 25, 2014.

    Effective for dates of service on or after Jan. 1, 2014, clinical diagnostic laboratory tests billed on TOB 14X are priced using the Clinical Lab Fee Schedule (CLFS). MHCP has identified and reprocessed 2014 date of service claims paid incorrectly through Feb. 11, 2014. Refer to your March 25, 2014, warrant for the corrected claims.

    Pathology Services, Technical Component

    For dates of service on and after October 1, 2013, MHCP pays the technical component rate for pathology services when billed on the 837I Institutional claim without the TC modifier. Due to delays in system work, some claims submitted prior to Dec. 17, 2013, denied incorrectly. MHCP replaced claims that were identified as incorrect denials. The replacements appear on Remittance Advices for the Feb. 11, 2014, payment date. Providers may replace any additional claims that are identified, or call the Provider Call Center for assistance.

    Primary Care and VFC Incentive Program

    MHCP identified claims that paid incorrectly for services eligible for enhanced rates:

  • • Child and Teen Checkup (C&TC) claims that paid incorrectly have been replaced and appear on the remittance advice for the March 25, 2014, payment date
  • • Vaccine claims that paid incorrectly are being identified. We will notify providers when a replacement date is available
  • Waiver/AC Program Providers

    Adjustment required to assure payment for residential services

    The April 1, 2014, COLA automation resulted in prorated units for January 1, 2014, through March 31, 2014. This caused some clients residential services on Service Authorizations to be authorized for fewer days than actually provided. MHCP is working on direction for counties and will notify counties as soon as we have more information.

    Changes to allowable settings for respite services

    Chapter 245D licensed respite services (unless excluded from 245D licensure) may be provided in one of the following sites

  • • Adult foster care homes
  • • Foster care homes for people under age 65
  • • Unlicensed site when the case manager has determined the site will meet the assessed needs of the individual

  • DHS updated the Community Based Services Manual (CBSM) respite service page to reflect this change.

    245D HCBS licensing
    Refer to the Home and Community-Based Services (HCBS) web page for information about 245D HCBS licensing.

    Related Links

    Visit our Provider website for more comprehensive information, including these pages:

  • Latest Manual Revisions
  • • Previously published Provider News items
  • Provider Updates (we also place newly published Provider Updates in your MN–ITS Mailbox, as appropriate)

  • This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) recipients. Get notices of Provider News through our free Provider Email Lists.

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.

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