MHCP Provider News

Dec. 15, 2014 News


  • • As part of its commitment to more person-centered supports, DHS contracted with the Institute on Community Integration at the University of Minnesota to offer a year-long training and technical assistance program. The intent of this program is to help agencies implement organizational changes for more person-centered supports. Review the Summary of Opportunity for details. The anticipated start date is April 2015. Applications are open to lead agencies (counties and tribes) and provider agencies. The application deadline is Jan. 30, 2015. For questions email Anne Roehl at vand0202@umn.edu.
  • • MHCP incorrectly calculated reimbursement amounts for some claims submitted Sept. 8 through Oct. 27, 2014, when Medicare applied coinsurance or a deductible to the service. We identified all of the affected claims; replacement claims appeared on the Nov. 18, 2014, remittance advice.
  • • The Continuing Care Administration reminds providers who serve people through a home and community-based services waiver, Alternative Care, Home Care and Intermediate Care Facilities for Persons with Developmental Disabilities that they need to submit a quality improvement project by Dec. 31, 2014. Submit projects through the Web-based Quality Improvement Tool to maintain the full 5% July 1, 2014, rate increase. More information is available on the Quality improvement requirement web page and in the Quality Improvement Project Plans memo.
  • • Review recent Provider Updates:
  • • Disability Services Division (DSD) VideoPresence Opportunity
  • Refer to the session for registration and session details.


    Systems Upgrade – Forms Issues

    If you are not able to open MHCP forms and documents, it may be because eDocs (our forms management system) recently underwent a system upgrade. As a result, the browser requirements have changed. If your browser does not meet these requirements, you will not be able to open PDFs in eDocs and need to update your browser.

    As of Nov. 18, 2014, to access forms in eDocs, you must have one of the following supported browsers:

  • • Microsoft Internet Explorer 9.x-11.x (We recommend that Compatibility View settings be disabled. To disable Compatibility View, go to Tools > Compatibility View Settings. Then uncheck Display intranet sites in Compatibility View. In Internet Explorer 9.x, also uncheck Display all websites in Compatibility View.)
  • • Mozilla Firefox 4.x or later
  • • Apple Safari 5.x or later
  • • Google Chrome 9.x or later

  • If you have more questions, refer to eDocs Frequently asked questions. We understand that changing or upgrading browsers can be difficult. Our IT area is actively looking for solutions that will allow older browsers to continue to work. Please contact the eDocs helpdesk (dhs.edocs.helpdesk@state.mn.us) if you have questions or problems with this change. We hope to minimize the impact in any way we can.

    If you have more questions, please call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.

    MN–ITS

    Refer to the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.

    Holiday hours and claims submissions
    The Provider Call Center will be closed several days during the upcoming holiday season. MN–ITS will be available, but staff will not be available on these days to help answer claims submission questions. Cut-off dates and scheduled days closed are:

  • • Dec. 25
  • • Jan. 1, 2015

  • MHCP recommends that you do not wait until the cut-off date to submit claims. Cut-off dates that coincide with holidays are Nov. 27 and Dec. 25. Submit claims early so staff is available to answer any questions you may have.

    Industry Initiatives

    This Industry Initiatives section gives 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

     

    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 Protecting Access to Medicare Act of 2014 (HR 4302) delayed implementation of ICD-10 until Oct. 1, 2015. Watch the ICD-10 page for updates.

       

    Pay-for-performance

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

    Audiology

    Audiology Services Billed on an 837I Outpatient Claim
    MHCP is working on a system change for payment of audiology services billed on the 837I outpatient claim. Effective for dates of service on or after Oct. 1, 2014, audiology services billed on the 837I will be considered an outpatient service and subject to follow Outpatient Prospective Payment Systems (OPPS) payment methodology.

    MHCP has identified affected audiology claims with dates of service on or after Oct 1, 2014. We will reprocess these claims and they will display on your Dec. 16, 2014, remittance advice.

    Chemical Health

    Consolidated Chemical Dependency Treatment Fund (CCDTF) providers must complete and submit the Annual Financial Statement Functional Expense Report (DHS-4445) for 2013 on or before Dec. 26, 2014. Minnesota Statutes requires all CCDTF providers to submit an annual financial statement functional expense report in a form approved by MHCP for each facility location or address. Refer to the CCDTF E-Memo for more information about this requirement.

    Durable medical equipment (DME), prosthetics and orthotics

    Capped rentals
    MHCP will reprocess and pay all capped rentals (CR) with a prior authorization (PA) and modifiers RR KJ that were overpaid due to bypass of a PA. They will be paid correctly at 75% of the actual rental rate. A mass adjustment that was scheduled to be done in October will now be done sometime in 2015. This was delayed due to systems problems with replacement claims that were not able to price correctly. We will update this message when the mass adjustment is scheduled. Refer to CMS MLNMatters for more information.

    Dually eligible recipients
    When Medicare is primary payer on Medicare paid lines, dually eligible recipients are subject to the round 2 competitive bidding single payment amount (SPA) under the Centers for Medicare and Medicaid Services (CMS) durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program. MHCP will do a mass adjustment back to July 1, 2013. We will post a notice when the mass adjustment is scheduled. Refer to the CMS DMEPOS Competitive Bidding Program and Laws of Minnesota, chapter 312, article 24, sec. 40, Reimbursement for basic care services, for more information.

    Family Planning

    (Added 12/22/14)
    Effective immediately, MHCP increased the maximum quantity limit for CPT code J7304 to nine units. This allows providers to prescribe a three-month supply of Ortho Evra patches at a time, matching the three-month supply currently allowed for oral contraceptives.

    FQHC and RHC

    Payment Methodology Election
    Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) must complete Alternative Payment Methodology Election for FQHCs and RHCs (DHS-3903) and choose the appropriate payment method. A separate form must be completed and returned for 2013, 2014 and 2015. Refer to Provider Update, Federally Qualified Health Centers (FQHC) and Rural health Centers (RHC) Alternative Payment Methodology Election (MHP-14-07) for more information.

    Legislative Change Conference Call
    DHS will hold a conference call on Dec. 18, 2014, 1:00-3:00 p.m. with Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC) and Managed Care Organizations (MCOs). We will discuss the changes resulting from implementation of the new law affecting FQHC and RHC payments for MHCP services that will be effective Jan. 1, 2015. During the call we will review and discuss the direct impact these changes will have on claim submission and payment tracking. We sent details of the call to the email addresses of chief financial officers (CFOs) and chief executive officers (CEOs) of the FQHCs and RHCs. MHCP advises representatives from all organizations to participate in the conference call. To participate, call in to the toll-free number about five minutes before the start time, then enter the conference code.

  • • Dial-in number: 888-742-5095
  • • Conference code: 6567611291
  • Hospital

    Outpatient Claims
    MHCP has identified a payment error on outpatient claims, billed on the 837I, with the following procedure codes: 36600, 43752, 71010, 71015, 71020, 94002, 94003, 94660, 94662, 94762, 99284, 99285, 99291 and G0384 for dates of service on or after Jan. 1, 2014. We will reprocess incorrectly paid claims on the Dec. 16, 2014, payment date.

    Mental Health Services

    Adult Rehabilitative Mental Health Services (ARMHS)
    Effective Jan. 1, 2015, or the date which federal approval is received, MHCP will cover functional assessments and individual treatment plans under ARMHS. Increases to existing ARMHS services have been proposed. We will reprocess claims as necessary to ensure that providers receive the rate effective for services provided on or after Jan. 1, 2015.

    DSM5 and WHODAS Frequently Asked Questions (FAQs)
    The Adult and Children’s Mental Health Divisions have published frequently asked questions and responses about the DSM5 and ICD-10 transition and the WHODAS assessment. Refer to the FAQs for more information:

    Nursing Facility

    Effective Jan. 1, 2015, nursing facilities will be required to submit a request for a refund of the spenddown amount withheld by DHS for clients in a managed care plan. Providers have no later than one year from the date of service or six months from the warrant date to request the refund.

    Outpatient Hospital

    (Added 12/16/14)
    Non-patient Laboratory Specimen

    Since July 9, 2014, outpatient claims billed with type of bill 14X and dates of service on or after Jan. 1, 2014, followed APC pricing. MHCP has completed programming to allow these outpatient claims to be priced using the Clinical Laboratory Fee Schedule (CLFS).

    MHCP replaced incorrectly paid claims on the Dec. 16, 2014, payment date.

    Waiver and AC Program Providers

    Quality improvement projects
    The Continuing Care Administration reminds providers who serve people through a home and community-based services waiver, Alternative Care, Home Care and Intermediate Care Facilities for Persons with Developmental Disabilities that they need to submit a quality improvement project by Dec. 31, 2014. Submit projects through the Web-based Quality Improvement Tool to maintain the full 5% July 1, 2014, rate increase. More information is available on the Quality improvement requirement web page and in the Quality Improvement Project Plans memo.

    Resource page for HCBS
    The Disability Services Division (DSD) has created a resource page to help providers and lead agencies during the Home and Community-Based Services reform process. Refer to DSD Announcement for details.

    Identification of 245D HCBS Providers
    Program directors: The Disability Services Division (DSD) needs to identify providers licensed under 245D who have immediate capacity to:

  • • Provide residential and home-based services to people with highly complex behavioral or medical support needs. Review the full DSD announcement.
  • • Provide consultation on person-centered planning and positive supports. The consultations will be with other 245D-licensed providers who serve people with highly complex behavioral or medical support needs. Review the full DSD announcement.

  • DHS will make a list of these providers available to lead agencies to use for making referrals. Review each of the DSD announcements to see a full description of the DHS request and how to submit your information.

    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 800-366-5411.

    Sign up to receive Provider Updates and other MHCP notices in your email account.


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