Medicare/Medicaid

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Notice from Medicaid on: EPSDT Mass Reprocessing Update

The Department of Community Health (DCH) has completed the first step in the reprocessing of the Health Check (HC) claims impacted by the ACA rate increase, implementation of the vaccine administration codes, and implementation of the NCCI edit for vaccine administration during the preventive health or office visit.

The impacted claims will be documented on an upcoming remittance advice. Some of these RAs may be extremely large. As a result of the adjustment:

  • Claims containing only the preventive and/or office visit codes that were billed correctly will be appropriately adjusted to include the increased rate amount for providers who have attested that they met the ACA provider rate increase criteria. For all other providers, these claims will reprocess as they did initially. These claims will not require further action.
  • Claims containing preventive and/or office visit codes, vaccine administration codes, and vaccine codes that were billed according to the guidance provided in the current EPSDT manual should be reviewed carefully by providers. ACA attested providers must review these claims to ensure they appropriately adjusted and included the increased rates for the preventive/office visit and the vaccine administration. All providers must review these claims to ensure they appropriately adjusted for vaccine administration during a preventive or office visit. Providers should review the vaccine administration codes, order of billing the vaccine administration codes and the vaccine product codes, and the NCCI modifiers on these claims to validate proper claims payment. If issues are identified, providers may adjust these claims.
  • Claims containing preventive and/or office visit codes, vaccine administration codes, and vaccine codes that were not billed according to the guidance provided in the current EPSDT manual will deny payment and providers will be required to resubmit those claims for proper payment.

A large number of COS 600 claims has been identified as needing to be reprocessed, therefore the reprocessing will occur over several weeks. Once all claims have been reprocessed, a window of time will be made available where eligible claims can be resubmitted electronically (either through the secure portal, through your billing vendor, or EDI/837 transaction). Please visit the provider portal, www.mmis.georgia.gov > Provider Information > Provider Notices > EPSDT Mass Reprocessing Reference Document, for additional guidance regarding resubmission.

DCH acknowledges that in the current Health Check Services (EPSDT) Manual, the E/M code 99211 is included in the listing of office visit codes that can be billed when vaccines are administered; however, the National Correct Coding Initiative (NCCI) does not allow reimbursement of the 99211 code when it is billed together with any of the vaccine administration codes regardless of whether the 25 modifier is appended to the 99211 code. This correction will be reflected in the April 1, 2014 version of the Health Check Services (EPSDT) Manual.

As a reminder, providers should administer vaccines during the preventive health visit (993xx codes). Vaccines may also be administered during the interperiodic (99201-99203 and 99212-99214), or sick visits. Providers should always add to the aforementioned codes, the EP and the 25 modifiers, when vaccines are administered during those visits. Providers must include the vaccine’s CPT and diagnosis codes along with the appropriate vaccine administration code(s) (90460, 90471-74) on their claims.

We encourage providers to visit the CMS website for information on the National Correct Coding Initiative. Providers are also encouraged to comply with the number of maximum units allowed for each vaccine administration code.

Click here to read about the AAFP and the Georgia Academy’s support of the Medicare Payment Solution (SGR) legislation.

Primary Care Provider Rate Increases Updated

Protection and Affordable Care Act (ACA) began enrolling providers for the Primary Care Provider Rate Increase on May 1, 2013. Physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine qualify as primary care providers for the rate increase. Sub-specialists within the primary care categories, including physicians who are board certified by the American Board of Physician Specialties (ABPS), the American Osteopathic Association (AOA), and the American Board of Medical Specialties (ABMS), are also eligible for the rate increase. Providers who attested on or before August 31, 2013 are eligible for the retroactive rate increase beginning January 1, 2013. We anticipate all adjustments will be completed by March 2014. The anticipated schedule for retrospective payments is below.

Peach State

Peach State will pay the increase for Q1 (2013) and Q2 (2013) by the end of February 2014.

Peach State will pay Q3 (2013) and Q4 (2013) thirty (30) days after receipt of the funds from DCH. Based upon DCH's reprocessing schedule, we anticipate Peach State will be able to make this payment in April 2014.

For current claims, Peach State will make supplemental payments on a quarterly basis.

Amerigroup

Amerigroup will have all of Q1, Q2, Q3, and Q4 of 2013 paid by April 2014.

For claims filed on or after February 1, 2014, Amerigroup will pay the eligible claims at the increased rate.

WellCare

WellCare will pay the increase for Q1 (2013) and Q2 (2013) by the end of February 2014.

WellCare will pay the increase for Q3 (2013) and Q4 (2013) by the end of April 2014.

For current claims, WellCare will make supplemental payments on a quarterly basis.

Please send additional questions to gapcplus@dch.ga.gov. Thank you for your continued support of the Georgia Medicaid program.

February 15, 2014

New Online Benefit Notification System from the Ga. Department of Human Services

ATLANTA - The Georgia Department of Human Services (DHS) announced a new update on January 7, 2014, which will allow families receiving monthly benefits to check their account notices online.

According to a press release from the Georgia DHS, this will include families receiving Medicaid, Food Stamps, and Temporary Assistance for Needy Families (TANF). These families may access notices regarding their benefits by logging onto their "My COMPASS" accounts online and clicking the "View My Notices" tab. The new online service is intended to enhance access for families and allow them to stay informed on the status of their benefits or any information they may require for the renewal of their benefits.

With the new "View My Notices" feature, families and individuals are able to view their previous 10 notices in an online PDF format.

The Georgia DHS also noted that this will not be the only enhancement made to Compass. Clients will eventually have the ability to opt-in for email notices on the status of their accounts.

In addition to new updates, individuals can also use the Compass website to check their potential eligibility for programs, apply for benefits, submit renewal applications, check the status of their benefits, and report changes to their accounts.

For more information, visit www.compass.ga.gov or http://dhs.georgia.gov/.

February 1, 2014