Medi-Cal Update

Clinics and Hospitals | May 2013 | Bulletin 464

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1. Payment Error Rate Measurement Program Review

The California Department of Health Care Services (DHCS) wishes to notify all California Medi-Cal providers of the Payment Error Rate Measurement (PERM) review that is being conducted in California by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS). The purpose of PERM is to identify erroneous payments made in Medicaid and the Children's Health Insurance Program (CHIP) in all 50 states and report improper payment estimates to Congress.

Approximately 167 Medi-Cal claims will be selected per quarter, between October 1, 2012, and September 30, 2013. Beginning in June 2013 and ending in July 2014, providers whose medical records have been selected for review will begin receiving requests from A+ Government Solutions, the review contractor (RC), for copies of medical records. The RC will collect the medical records for sampled claims from providers via secure fax and mail to perform medical and data processing reviews to determine if the claims were paid correctly.

Providers will also be required to send a duplicate copy of the medical records requested by the RC to DHCS. DHCS is taking this proactive step in order to review the submitted documentation and determine if further information is needed to support the claim. In cases where DHCS determines that the medical records have not been submitted or further information is needed, providers will be contacted by a DHCS representative, either by telephone or in person, to help facilitate obtaining copies of this important documentation.

DHCS is urging all providers to comply with requests for medical records from the RC and DHCS. Failure to comply with the request from the RC will result in an error being counted against California, and DHCS will be required to recover the claim payment amount from providers. Your cooperation will help ensure that the payment measurement rate is accurate and that California retains its much needed federal match monies for the Medi-Cal Program.

CMS is hosting a PERM Provider Education Webinar/Conference Call on June 5, 2013, from noon to 1 p.m. PST. DHCS hopes that all Medi-Cal and CHIP providers will take advantage of the opportunity to learn about PERM, receive information about the responsibility of providers selected for PERM review, and ask questions and provide feedback to CMS and DHCS representatives. Please join the meeting using the following webinar and conference call information:

For further information about the fiscal year 2013 PERM, visit the CMS PERM website or the DHCS PERM website. Email questions about PERM to DHCS at PERM@dhcs.ca.gov.

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2. Tobacco Cessation Counseling for Pregnant and Postpartum Women

Effective October 1, 2012, under Medi-Cal and the Comprehensive Perinatal Services Program, providers must offer one, face-to-face smoking/tobacco cessation counseling session and a referral to a tobacco cessation quitline to pregnant and postpartum recipients, as recommended in Treating Tobacco Use and Dependence: 2008 Update, a U.S. Public Health Service Clinical Practice Guideline.

Such counseling and referral services must be provided to pregnant and postpartum recipients without cost sharing. These services are required during the prenatal period through the postpartum period (the end of the month in which the 60-day period following termination of the pregnancy ends).

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
General Medicine
Obstetrics
Outpatient Clinics and Hospitals
preg com (3); preg early (2); preg post (1)
Home Health Services/Home and Community-Based Services
Inpatient Services
preg post (1)
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3. Every Woman Counts Income Eligibility Guidelines Update

Effective April 1, 2013, through March 31, 2014, Every Woman Counts (EWC) providers are to use the following EWC Income Eligibility Guidelines chart to determine income eligibility. Providers should disregard all previous Income Eligibility Guidelines charts.

EWC recipients must have a household income at or below 200 percent of the federal Health and Human Services (HHS) poverty guidelines. The HHS poverty guidelines are adjusted annually. “Gross income” means income before taxes and other deductions.

Updated manual replacement pages will be published in a future Medi-Cal Update.

EWC INCOME ELIGIBILITY GUIDELINES
200 Percent of the 2013 HHS Poverty Guidelines by Household Size
Effective April 1, 2013, through March 31, 2014
Number of Persons Living in Household Monthly Gross Household Income Annual Gross Household Income
1 $1,915 $22,980
2 $2,585 $31,020
3 $3,255 $39,060
4 $3,925 $47,100
5 $4,595 $55,140
6 $5,265 $63,180
7 $5,935 $71,220
8 $6,605 $79,260
For each additional person, add: $670 $8,040

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Outpatient Clinics and Hospitals
General Medicine
Obstetrics
ev woman (9)
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4. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective May 1, 2013
NDC Labeler Code Contracting Company's Name
76325 HYPERION THERAPEUTICS, INC.
 
Termination, effective July 1, 2013
NDC Labeler Code Contracting Company's Name
00276 MISEMER PHARMACEUTICAL, INC.
75840 GENPAK SOLUTIONS LLC
   
Voluntary termination, effective July 1, 2013
NDC Labeler Code Contracting Company's Name
00072 WESTWOOD-SQUIBB PHARMACEUTICALS
14168 STONEBRIDGE PHARMA LLC
40042 PHARMAFORCE, INC.
46129 PALADIN LABS (USA), INC.
   

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (2, 4, 6, 8, 9, 18)
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5. Improving the Quality of Care: Therapeutic Monitoring in Diabetes

Drug Use Review - Educational Information

Key Points

Background
Diabetes is the seventh leading cause of death in the United States and is the leading cause of kidney failure, non-traumatic lower limb amputations and new cases of blindness among American adults.1 Additional diabetes-related complications include heart disease, stroke, hypertension and nervous system damage.1

Intensive glycemic control significantly reduces microvascular complications, including retinopathy, nephropathy and neuropathy.2-4 Clinical studies and meta-analyses evaluating the effect of statins on control of low-density-lipoprotein cholesterol (LDL-C) have established a reduction in cardiovascular disease outcomes, vascular mortality and all-cause mortality.5-7

American Diabetes Association Guidelines for Comprehensive Diabetes Care
Recently, the American Diabetes Association (ADA) published Standards of Medical Care in Diabetes – 2013, which gives health care providers information regarding diabetes diagnosis, general treatment and tools to evaluate quality of care.8 General targets relevant to most patients with diabetes are provided, while also accounting for patient-specific factors that may favor individualized targets in certain patients. In general, the following monitoring guidelines are recommended:

Medicaid Initial Core Set of Health Care Quality Measures
Comprehensive diabetes care is one of Medicaid's initial core set of health care quality measures published in 2012.9 These quality measures differ from the ADA's Standards of Medical Care and are based on the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) diabetes performance measures.10 These measures include:

One study that used the HEDIS comprehensive diabetes care performance measures to evaluate Medicaid fee-for-service beneficiaries across all 50 states found that the rates of HbA1C and lipid panel monitoring in the Medicaid fee-for-service population were approximately half the rates of other insurers and populations.11 In addition, they found that 17.8 percent of this population with diabetes had a co-morbid mental health condition, and when monitoring rates were stratified, the rates were even lower among those with at least one co-morbid mental health condition, confirming other research that identified co-morbid mental health conditions as an important risk factor for reduced quality of diabetes care in the United States.11-15 In Standards of Medical Care in Diabetes – 2013, the ADA notes that psychological problems may impair an individual's ability to carry out diabetes-related self-management tasks and compromise health.8

Methods
A retrospective cohort study was conducted to assess rates of HbA1C and LDL-C monitoring in the Medi-Cal fee-for-service population, using pharmacy and medical claims data collected during the measurement year between October 1, 2011, and September 30, 2012. The study population included all Medi-Cal fee-for-service beneficiaries aged 18 – 64 years who were continuously eligible in the Medi-Cal fee-for-service program for at least 11 of the 12 months in the measurement year and met case selection criteria for diabetes.

Case selection criteria for diabetes were adapted from HEDIS performance indicators,10 and included beneficiaries who met one or both of the following criteria:

Diabetes performance measures during the measurement year (Hb1Ac and lipid panel monitoring rates) were calculated using standardized specifications.10 Further, using the methodology described by Druss, et al.,11 each Medi-Cal fee-for-service beneficiary meeting inclusion criteria for diabetes also was evaluated to determine whether or not they had a co-morbid mental health condition. Beneficiaries were classified as having a co-morbid mental health condition if they had a medical claim that included an ICD-9-CM code for any mental disorder, excluding organic conditions such as dementia and delirium (ICD-9-CM codes 295.00-315.99).

Results
A total of 132,033 Medi-Cal fee-for-service beneficiaries met the inclusion criteria for diabetes during the measurement year. Of these, 46.7 percent (n = 60,339) were identified as having a co-morbid mental health condition. A summary of the stratified HbA1C and lipid panel monitoring rates for the Medi-Cal fee-for-service population is presented in Table 1. Also included for reference are the findings from the previous study of the Medicaid fee-for-service population, which included data across all 50 states.

Table 1. Hemoglobin A1C (HbA1C) and Lipid Panel Monitoring Rates.
HEDIS Measures Medi-Cal fee-for-service beneficiaries with diabetes (n = 132,033) National Medicaid fee-for-service beneficiaries with diabetes (n = 657,628)11
With co-morbid mental health condition(n = 60,339) Without co-morbid mental health condition (n = 71,694) With co-morbid mental health condition (n = 118,190) Without co-morbid mental health condition (n = 539,438)
At least one HbA1C screening during measurement year 21.6% 28.3% 43.8% 47.0%
At least one LDL screening during measurement year 18.4% 25.6% 24.4% 26.9%

Medi-Cal fee-for-service HbA1C and lipid panel monitoring rates are below those found in a sample of the national Medicaid fee-for-service population, with the lowest rates of monitoring in both study populations being those beneficiaries with a co-morbid mental health condition.

Strategies to Improve Comprehensive Diabetes Care
There is much room for improvement in the HbA1C and lipid panel monitoring rates for all patients with diabetes in the Medi-Cal fee-for-service population, especially among beneficiaries who have a co-morbid mental health condition. Due to the risks associated with second-generation atypical antipsychotic medications, psychiatrists treating patients with these medications are encouraged to perform regular therapeutic monitoring, including fasting glucose and lipid profiles, for patients with serious mental illness who may not be willing or able to obtain this monitoring through traditional primary care mechanisms.16

HbA1C and LDL screening results can help providers assess the effectiveness of treatment, tailor treatment regimens, and act as an early warning signal for possible diabetes-related complications. By improving screening rates among the entire population, there can be benefits to both healthcare costs and clinical outcomes.

There have been different strategies implemented by different health plans across the nation. The Agency for Healthcare Research and Quality (AHRQ) has published different strategies for improving diabetes care.17 Strategies that involve both the provider and patient may improve comprehensive diabetes care measures.

These strategies should be considered for implementation to improve comprehensive diabetes care: patient education, promotion of self management and patient reminders. Patient education involves informing the patient about the disease, management strategies and possible complications through printed materials, audio/visual materials or face-to-face meetings. Promotion of self management includes providing resources to the patient to become more personally involved in their health management. Lastly, patient reminders include any effort created to encourage patients to keep or make appointments, including screenings. Previous research has shown that using more than one strategy provides greater benefit than using a single strategy.17

Clinical Recommendations

Acknowledgement
The Medi-Cal DUR program would like to thank the staff of the California Diabetes Program for providing resources as part of clinical recommendations in this bulletin. The California Diabetes Program is a partnership between the California Department of Public Health (CDPH) and the University of California, San Francisco, funded primarily by the Centers for Disease Control and Prevention (CDC). The mission of the California Diabetes Program is to prevent diabetes and its complications in California's diverse communities.

References

  1. Centers for Disease Control and Prevention (CDC). National diabetes fact sheet: national estimates and general information on diabetes and pre-diabetes in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC); 2011. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed: March 14, 2013.
  2. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28: 103 – 117.
  3. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352: 854 – 865.
  4. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837 – 853.
  5. Kearney PM, Blackwell L, Collins R, et al.; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008; 371:117 – 125.
  6. Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361:2005 – 2016.
  7. Goldberg RB, Mellies MJ, Sacks FM, et al.; the Care Investigators. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. Circulation. 1998; 98: 2513 – 19.
  8. American Diabetes Association. Standards of Medical Care in Diabetes – 2013. Diabetes Care. 2013 Jan;36(1):S11 – S64. Available at: http://care.diabetesjournals.org/content/36/Supplement_1/S11.full.pdf+html. Accessed: March 14, 2013.
  9. U.S. Department of Health and Human Services. Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults. Federal Register Volume 77, Issue 2 (4 Jan 2012), pp. 286 – 291. Available at: http://www.gpo.gov/fdsys/pkg/FR-2012-01-04/pdf/2011-33756.pdf. Accessed: March 14, 2013.
  10. Centers for Medicare & Medicaid Services. Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid (Medicaid Adult Core Set): Technical Specifications and Resource Manual for Federal Fiscal Year 2013. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-Adult-Core-Set-Manual.pdf. Accessed: March 12, 2013.
  11. Druss BG, Zhao L, Cummings JR, Shim RS, Rust GS, and Marcus SC. Mental comorbidity and quality of diabetes care under Medicaid. Med Care. 2012:50(5)428 – 433.
  12. Frayne SM, Halanych JH, Miller DR, et al. Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005;165:2631 – 2638.
  13. Clark RE, Weir S, Ouellette RA, et al. Beyond health plans: behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries. Med Care. 2009;47:545–552.
  14. Leung G, Zhang J, Lin WC, et al. Behavioral disorders and diabetes-related outcomes among Massachusetts Medicare and Medicaid beneficiaries. Psychiatr Serv (Washington, DC). 2011; 62:659 – 665.
  15. Banta JE, Morrato EH, Lee SW, et al. Retrospective analysis of diabetes care in California Medicaid patients with mental illness. J Gen Intern Med. 2009;24:802 – 808.
  16. Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334–49.
  17. Shojania KG, Ranji SR, Shaw LK, Charo LN, Lai JC, Rushakoff RJ, McDonald KM, and Owens DK. Closing the quality gap: a critical analysis of quality improvement strategies. AHRQ Publication. September 2004. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap2/qualgap2.pdf. Accessed: March 14, 2013.
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6. Policy Clarification for Wearable Cardiac Defibrillators

Cardiology policy text for wearable cardiac defibrillators (WCDs) in the Cardiology section of the Part 2 provider manual has been revised for improved clarity. The policy itself has not changed.

Providers are reminded that, due to the high cost of this item and its anticipated use as a short term “bridge” to a change in the recipient's status, a Treatment Authorization Request (TAR) for this item is required for reimbursement and limited to a maximum of one month's approval. If usage beyond one month is necessary, another TAR is required.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
cardio (11)
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7. Neurostimulator Codes Now Primary Surgeon Benefits

Effective for dates of service on or after June 1, 2013, three CPT-4 codes regarding neurostimulator procedures become primary surgeon benefits. The codes and descriptions are:

Code Description
64575 Incision for implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)
64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling
64595 Revision or removal or peripheral or gastric neurostimulator pulse generator or receiver

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
General Medicine
Inpatient Services
Obstetrics
Outpatient Clinics and Hospitals
tar and non cd6 (3)
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8. Paclitaxel Protein-Bound Particles Policy Update

Effective for dates of service on or after June 1, 2013, HCPCS code J9264 (injection, paclitaxel protein-bound particles, 1mg) may be used in the treatment of locally advanced or metastatic non-small cell lung cancer, as first-line treatment in combination with carboplatin, in patients who are not candidates for curative surgery or radiation treatment.

Paclitaxel protein-bound particles (J9264) is reimbursable when billed in conjunction with ICD-9-CM diagnosis codes 162.2 – 162.9 or 174.0 – 175.9. The maximum dose of 500 mg will be removed.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
chemo drug p-z (1, 4)
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9. Overactive Bladder Treatment Added to OnabotulinumtoxinA Benefits

Effective for dates of service on or after June 1, 2013, treatment of overactive bladder will be added to HCPCS code J0585 (injection, onabotulinumtoxinA, 1 unit) as a benefit. Overactive bladder is defined as having symptoms of urge urinary incontinence, urgency and frequency in adults who have an inadequate response to, or are intolerant of, an anticholinergic medication.

Providers can view the onabotulinumtoxinA benefits in the Injections: Drugs A-L Policy section of the appropriate Part 2 provider manual.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitation Clinics
inject drug a-l (9)
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10. Quantity Update for Unilateral Procedures Billed

CPT-4 codes 92225, 92226, 92230, and 92235 are considered unilateral services. Effective retroactively for dates of service on or after December 1, 2012, the quantity allowed per day for CPT-4 codes 92225, 92226, 92230, and 92235 is two procedures, reimbursed at 200 percent when these services are performed on both eyes (bilaterally).

When performed on both eyes as a bilateral procedure, claims must be billed on a single line using modifier 50 (bilateral procedure) with a quantity of "2."

When performed on one eye as a unilateral procedure, claims must be billed with a quantity of "1" and either modifier LT (left side) or RT (right side) to indicate which eye.

CPT-4 Code Description
92225* Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial
92226 subsequent
92230 Fluorescein angioscopy with interpretation and report
92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report

*Note:

CPT-4 code 92225 is reimbursable to optometrists as well as ophthalmologists.

Providers can view more information in the Professional Services and Ophthalmology sections of the appropriate Part 2 provider manuals.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
ophthal (2, 3)
Vision Care pro serv (19, 20)
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11. Diagnosis Codes Required for Nerve Block Injections

Effective for dates of service on or after June 1, 2013, the descriptor for CPT-4 codes 64493–64530 (injection(s), diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint or facet joint [or nerves innervating that joint] nerve with image guidance [fluoroscopy or CT], lumbar or sacral) has been updated in the Surgery: Nervous System section of the Part 2 provider manual.

CPT-4 codes 64493–64530 require modifier 50 for bilateral procedures and are reimbursable only when billed in conjunction with one of the following ICD-9-CM codes:

Code Description
721.3 Lumbosacral spondylosis without myelopathy
721.42 Thoracic or lumbar spondylosis with myelopathy, lumbar region
722.52 Degeneration of lumbar or lumbosacral intervertebral disc
722.83 Postlaminectomy syndrome, lumbar region
724.02 Spinal stenosis, lumbar region, without neurogenic claudication
724.2 Lumbago
724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified
756.11 Spondylolysis, lumbosacral region

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
surg nerv (1)
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12. Update to Language in IHS/MOA in Accordance with State Plan Amendment

Language has been removed from the Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics section related to reimbursement for ambulatory visits to make the manual consistent with the State Plan Amendment (SPA) 09-001, which amended Supplement 6 to Attachment 4.19-B, approved by the Centers for Medicare & Medicaid Services (CMS) on May 23, 2011, with the effective date of July 1, 2009. The language removed is related specifically to face-to-face visits.

The following language was removed from the Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics section in accordance with the SPA revision:

A face-to-face visit may include services provided by the IHS/MOA provider in a recipient’s place of residence, which may be a nursing facility or other institution.

A face-to-face visit is also recognized for services furnished in a hospital or other facility by the IHS/MOA provider if the visit is necessary for continuity of care, providing that:

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Adult Day Healthcare Centers
Outpatient Clinics and Hospitals
ind health (4, 5)
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13. June 2013 Medi-Cal Webinars

Beginning June 4, 2013, and continuing throughout the month of June, Xerox State Healthcare, LLC, the DHCS Fiscal Intermediary (FI) for Medi-Cal, invites you to participate in Medi-Cal provider training webinars. The webinars will be as follows:

The June webinars will include a new Diagnosis-Related Group (DRG) billing class.

All recorded webinars will be archived in the Medi-Cal Learning Portal. If you are unable to attend a webinar, you can view it at a more convenient time.

To view the training webinars, you must have Internet access and a user profile in the Medi-Cal Learning Portal. For more detailed instructions about the registration process and how to access webinar classes, please visit the Outreach and Education page of the Medi-Cal website.

Join us online and take advantage of this exciting initiative from Medi-Cal.

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14. National Correct Coding Initiative Quarterly Update for April 2013

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and applied to claims retroactive for dates of service on or after April 1, 2013. For further information, please refer to the National Correct Coding Initiative in Medicaid page of the Medicaid website.

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15. Provider Orientation

Family PACT

Medi-Cal providers seeking enrollment in the Family PACT (Family Planning, Access, Care and Treatment) Program are required to attend a Provider Orientation. Dates for upcoming Orientations are listed below. Registration opens at 8 a.m. and the Orientation begins promptly at 8:30 a.m.

Individual and group providers wishing to enroll must send a physician-owner to the session. Non-profit and government clinics seeking to enroll must send their medical director, physician or nurse practitioner who is responsible for oversight of medical services rendered at the service site where the provider wants to enroll.

Office staff members, such as clinic managers, billing supervisors and client eligibility enrollment supervisors, are welcome to attend. However, these staff members are not eligible to receive a Certificate of Attendance. Online modules and previously recorded webcasts are available on the Provider Training page of the Family PACT website for currently enrolled providers and their staff to view to remain current with program policies and services.

Provider Orientation Highlights

Please note the upcoming Provider Orientations:

Sacramento
May 30, 2013
8:30 a.m. – 4 p.m.
East End Complex Training Center
1500 Capitol Avenue
Sacramento, CA 95814
(916) 324-0389
Los Angeles
June 18, 19 or 20, 2013
3 Orientations – Space Limited
8:30 a.m. – 4 p.m.
The California Endowment Center
1000 North Alameda Street
Los Angeles, CA 90012
(213) 928-8613

To register for an Orientation, providers should:

Registration is to be submitted in an electronic format. If you experience problems using the “submit” button, please fax the registration form to (916) 440-5634.

Check-In
Check-in begins at 8 a.m. Orientations start promptly at 8:30 a.m. and end by 4 p.m. At the Orientation, providers must present the following:

Note:

Individuals representing a clinic or physician group should use the clinic or group NPI, not an individual NPI or license number.

Certificate of Attendance
Upon completion of the orientation session, each prospective new Family PACT medical provider will receive a Certificate of Attendance. The original certificate will be retained by the Department of Health Care Services, Office of Family Planning, Family PACT Provider Enrollment, along with the provider’s completed Family PACT application. Providers arriving late or leaving early will not receive a Certificate of Attendance. Currently enrolled Family PACT providers do not receive a certificate.

Contact Information
For more information about the Family PACT Program, please call 1-800-942-1054 or visit the Family PACT website.

The Family PACT Program was established in January 1997 to expand access to comprehensive family planning services for low-income California residents.

 

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16. Subscribe Today to Receive Medi-Cal Notifications via Email

Providers are invited and encouraged to subscribe to the Medi-Cal Subscription Service (MCSS), where subscribers receive email notification of urgent, high-impact announcements and/or monthly Medi-Cal Update bulletins when posted on the Medi-Cal website. Subscribers can choose specific provider communities or subject matters, making it easier to stay up-to-date on the latest Medi-Cal news.

Subscribing to MCSS is easy; go to the MCSS Subscriber Form on the Medi-Cal website and complete the following steps:

  1. Enter an email address and a ZIP code
  2. Select the specific subject matter areas of interest for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts
  3. A confirmation email will be sent to the registered email; click the subscription confirmation link and the registration process is complete

    Note:

    If subscribers are unable to find the subscription confirmation email in their inbox, they should check their junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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17. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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