Medi-Cal Update

Hospice Care Program | November 2017 | Bulletin 518

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1. New Revenue Codes Required for Routine Home Care Outpatient Services

Federal Rule 42 CFR Part 418, CMS–1629–F, RIN 0938–AS39 Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements establishes an updated reimbursement rate of differential payments for routine home care based on the recipient's length of stay, and implements a service intensity add-on (SIA) payment for services provided by a registered nurse or social worker in the last seven days of a recipient’s life for at least 15 minutes and up to four hours total per day.

Effective retroactively for dates of service on or after January 1, 2016, with a projected implementation date in February 2018, hospice providers are required to bill new revenue codes for routine home care services on outpatient claim forms.

The existing local Medi-Cal revenue code 0651 (hospice service, routine home care) will be end-dated and replaced by three new, HIPAA-compliant revenue codes:

Upon implementation of this project, providers can void old claims that used the obsolete hospice routine home care revenue code/procedure code (listed below) and resubmit using the new methodology described above.

Additionally, providers will be requested to complete two new fields on the outpatient claim form: Admission Date (Box 12) and Patient Status (Box 17). The data captured in these fields will be used as informational data to assist Audits and Investigations (A&I) in verifying the validity of routine home care claims. Subsequent bulletins will provide information regarding specific data allowed for these fields.

Additional information for this project will publish as details are determined.

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2. Coming Soon: Online PDF RAD and Medi-Cal Financial Summary

Providers will soon be able to securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary. The PDF RADs will be available on the Medi-Cal website under the Transactions Services tab.

Note:  To access the transaction, providers must have a signed Medi-Cal Point of Service (POS) Network/Internet Agreement form on file, an NPI and PIN.

Benefits of PDF RAD
There will be many benefits to accessing RAD and Medi-Cal Financial Summary information online:

No provider payments will be made via PDF RADs. They will be informational only.

Providers should refer to future Medi-Cal Update bulletins for additional information.

Providers also are encouraged to sign up for the ASC X12N 835 transaction using the Electronic Health Care Claim Payment/Advice Receiver Agreement form (DHCS 6246 form). The form, which is expected to be modified in December, is located on the Forms page of the Medi-Cal website (www.medi-cal.ca.gov). The Medi-Cal website contains 835 transactions generated for the last six weeks. For information about 835 transactions, providers may refer to “ASC X12N 835 Transaction” in the Part 1 Medi-Cal provider manual section, Remittance Advice Details (RAD): Electronic.

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3. 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 October 1, 2017
NDC Labeler Code Contracting Company's Name
69809 HLS THERAPEUTICS (USA), INC.
69865 DEPO NF SUB, LLC
70437 PUMA BIOTECHNOLOGY, INC.
70510 MITSUBISHI TANABE PHARMA AMERICA, INC.
70655 RENAISSANCE LAKEWOOD, LLC.
71090 STRONGBRIDGE U.S. INC.
   
Terminations, effective October 1, 2017
NDC Labeler Code Contracting Company's Name
11528 CENTRIX PHARMACEUTICAL, INC.
42546 PRUGEN, INC.
69437 CANTON LABORATORIES, LLC.

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 (6, 8, 18, 19)
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4. RTD Generation to be Discontinued in Multiple Phases

The Department of Health Care Services (DHCS) will be phasing out the generation of Resubmission Turnaround Documents (RTDs) (Form 65-1) over the next 12 months. The discontinuation of RTDs will both increase claims processing efficiency and reduce costs.

RTDs will be discontinued in multiple phases. The new process will deny claims submitted with questionable or missing information instead of generating an RTD. As DHCS transitions from the use of RTDs to claim denials, providers can expect to receive fewer RTDs. When the project is completed, the use of RTDs will be completely discontinued.

The implementation of each RTD phase-out period will be announced in a future monthly bulletin. Providers are encouraged to routinely check the Medi-Cal website for more information.

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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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