Click here to help your patients find the least expensive Medicare Part D Drug Plan and Medicare Advantage Plan which meets their needs.
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 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 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 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 firstname.lastname@example.org. Thank you for your continued support of the Georgia Medicaid program.
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.
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.