Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | August 2017 | Bulletin 515

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2. 2017 CPT-4/HCPCS Annual Update: Policy Updates

The 2017 updates to the Current Procedural Terminology – 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2017 CPT-4/HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after October 1, 2017. Please refer to the 2017 CPT-4 and HCPCS Level II code books for complete descriptions of these codes. Manual replacement pages reflecting these changes will be released in a future Medi-Cal Update.

Additionally, the 2017 CPT-4 codebook was updated to allow separate reimbursement for moderate (conscious) sedation for multiple codes that had previously included moderate (conscious) sedation as an inherent part of providing the procedure. Please refer to the 2017 CPT-4 codebook for instructions on how to bill for this service with other codes.

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3. Reminder to FQHC/RHC/IHS-MOA Providers of Upcoming Code Conversion

Effective for dates of service on or after October 1, 2017, claims billed with Healthcare Common Procedure Coding System (HCPCS) Level III local per-visit codes, except for local per-visit code 03 for dental services, will no longer be eligible for reimbursement and will be denied.

Claims submitted by Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Services-Memorandum of Agreement (IHS-MOA) providers without a valid code set for dates of service on or after October 1, 2017, will be denied. Providers have three options for countering a denied claim:

Providers may request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers calling from outside of California can contact TSC at 1-916-636-1200.

For additional information, providers may:

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4. FQHC/RHC/IHS-MOA Code Conversion Reminder

Effective for dates of service on or after October 1, 2017, the FQHC/RHC/IHS-MOA code conversion will establish HIPAA-compliant billing code sets for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services-Memorandum of Agreement (IHS-MOA) 638, clinics.

The Health Insurance Portability and Accountability Act (HIPAA) was authorized by Congress in 1996. HIPAA mandates uniform, national standards for information submitted by health care providers on claims, including health care services, procedures and personal health information.

These HIPAA-compliant billing code sets will replace local codes currently in use by FQHCs, RHCs and IHS-MOA clinics for medical and/or mental health services. Code crosswalks for this conversion are available on the HIPAA: Code Conversions Web page of the Medi-Cal website under the FQHC/RHC/IHS-MOA area:

Note:

New code sets listed in these crosswalks will be billable on or after October 1, 2017.

Additional information regarding this code conversion will publish throughout 2017 in the NewsFlash, Medi-Cal Update and on the HIPAA: Code Conversions Web page.

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5. FQHC/RHC/IHS-MOA Local Code Conversion Webinars in October and November 2017

Providers have the opportunity to attend free online webinars pertaining to the October 2017 code conversion implementation and billing requirements for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services-Memorandum of Agreement (IHS-MOA) 638, facilities. The webinar will be presented live through the Medi-Cal website on Thursday, October 19, at 11 a.m. and Wednesday, November 1, at 9 a.m.

First-time webinar attendees must register online at the Medi-Cal Learning Portal prior to attending. Once registered, select “Course Catalog” from the menu and then select “Calendar View” to locate the appropriate webinar.

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6. September 2017 Medi-Cal Provider Seminar

The September Medi-Cal provider seminar is scheduled for September 26 – 27, 2017, at the Ontario Convention Center in Ontario, California. Providers can access a class schedule for the seminar by visiting the Provider Training page of the Medi-Cal Learning Portal (MLP), and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the DHCS Fiscal Intermediary conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by September 12, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 12, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative web page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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