Are You Ready for ICD-10?
Whether you're a physician, hospital, or practice manager, your practice will be dramatically affected by the mandatory transition from ICD-9 to ICD-10 code sets. The Department of Community Health (DCH) is offering webinars to help you prepare. You may attend live or on-demand.
Space is limited for the live presentation, so we encourage you to register today by clicking here or inserting this link into your browser: https://dchevents.webex.com/dchevents/onstage/g.php?t=a&d=665386535. Once your registration has been received, a confirmation email will be sent to you with the log-in information and WebEx tips to make sure your system is compatible.
To view any of their webinars later: Check out the DCH website for a link to the on-demand presentation of this webinar to be posted within 48 hours of the live presentation. Visit www.dch.georgia.gov/IT-Events.
Upcoming 2013 Webinars* -- Register Now
All live webinars begin at 10:30am.
August 15 ICD-10 Clinical Close-up: Part 1
August 22 ICD-10 Clinical Close-up: Part 2
Sept. 10 Medicaid Policy Update & ICD-10
Sept. 17 Trading Partners: Testing Readiness with DCH
Sept. 25 Providers: Testing Readiness with DCH
Oct. 15 Pre-Testing Readiness & Troubleshooting
Oct. 29 Open Discussion, Q&A on ICD-10
To register for any of the above webinars and to get the latest information about upcoming ICD-10 webinars and events, please visit the DCH website (www.dch.georgia.gov/IT-Events) and the Georgia Medicaid Management Information System (GAMMIS) website (www.mmis.georgia.gov). DCH and Georgia Medicaid's planned ICD-10 testing date for providers is 1st quarter 2014.
*Please note: the above dates and topics are subject to change.
Medicare Initiatives and You: Bonuses and Penalties
The AAFP has created resources to help you make sense of Medicare initiatives. To learn how the bonuses and penalties associated with key Medicare initiatives may impact your bottom line, view the AAFP's Medicare Initiatives and You: Bonuses and Penalties document.
OPR Providers Required to Enroll in Medicaid Program
Traditionally, physicians are enrolled in Georgia Medicaid to provide services to Medicaid beneficiaries and to submit claims for these services. However, the Affordable Care Act (ACA) now requires physicians to enroll in the Medicaid Program to order, prescribe, and refer - even if they do not submit claims to Medicaid. Physicians who order, prescribe for, or refer Medicaid beneficiaries, but do not submit claims to Medicaid are referred to as Ordering, Prescribing and Referring (OPR) providers. This new requirement does not apply to physicians who care for those enrolled in a Medicaid CMO; it is applicable only to the Fee for Service (FFS) Medicaid Program.
Effective April 1, 2013, OPR providers may begin enrolling in the FFS Medicaid Program, or as an OPR provider. Beginning July 1, 2013 any claim submitted will be denied if the NPI number on the claim is associated with a provider who is not participating in Medicaid FFS or enrolled as an OPR provider.
The Georgia Department of Community Health, which oversees Georgia Medicaid, has released additional information regarding the requirements and the enrollment process, and it can be accessed at: http://dch.georgia.gov/sites/dch.georgia.gov/files/related_files/site_page/OPR_FAQ_03-19-13.pdf.
Physicians Required to have NPI to Receive Medicare Payments
On May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin instructing its contractors to deny Medicare claims from providers who do not include a valid National Provider Identifier (NPI).
Section 6405 of the Affordable Care Act requires physicians to be enrolled in the Medicare program to order or refer items or services for Medicare beneficiaries. Also, Medicare requires that a physician or supplier that bills Medicare for a service or item show the name and unique identifier (i.e., the NPI) of the attending physician on the claim if that service or item was the result of an order or referral.
Physicians can enroll in the Medicare program at the Internet-Based Provider Enrollment, Chain, and Ownership System (PECOS) webpage: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare.
For additional information visit: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf.
Vaccine Administration Billing Changes for Health Check Providers
The Georgia Department of Community Health (DCH) has posted a new banner message for Health Check providers regarding changes in billing and payment of vaccine administration. The vaccine administration fee rate has been revised; it is now $10 for any vaccine for the Medicaid Fee for Service (FFS) population and $18.50 for any vaccine for the PeachCare for Kids population.
Georgia DCH has also opened the billing code 90460, effective March 1, 2013. Providers are to use this code going forward to bill for the vaccine administration fee. Instructions about how to use this code are in the banner message. Additionally, a new National Correct Coding Initiative (NCCI) edit has led to the requirement that providers use the '25' modifier with the Health Check visit code when they administer vaccines during the Health Check visit and bill the 90460 code.
Providers may resubmit their vaccine administration fee claims, dated January 1, 2013 or later, for reprocessing on or after March 1, 2013, in order to receive the higher reimbursement rate. If you have questions, contact HP Enterprise Services Contact Center at 770.325.9600 or 800.766.4456.
These measures lay the groundwork for the increased reimbursement that will be available under the Affordable Care Act. To view this and other Department of Community Health Banner Messages, visit: www.mmis.georgia.gov and select Provider Information from the top navigation bar.