Medi-Cal Update

Hospice Care Program | April 2018 | Bulletin 523

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1. Hospice Routine Home Care Updates

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 system implementation date of May 1, 2018, hospice providers are required to bill new revenue codes for routine home care services and SIA.

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

Providers are required to make sure that the number of days billed for any per-diem hospice service matches the number of days represented in the from-through service date range.

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 codes described above:

Also, providers are requested to complete two additional fields on the outpatient claim form: Admission Date (Box 12) and Status (Box 17).

outpatient claim form

The data captured in these fields will be used to assist Audits and Investigations (A&I) in verifying the validity of routine home care claims. Some applicable data values allowed for the Status field (Box 17) are:

Providers are instructed to include any transfer information for the recipient from their previous hospice stay, including the National Provider Identifier (NPI) of the facility and admission and transfer dates. A&I will address any text placed in the field.

Upon implementation of the new revenue codes, providers will have the following options to void claims and prepare to submit claims with the new codes, effective retroactively for dates of service on or after January 1, 2016:

The following is an example series of events for submission of a CIF and appeal for a previously paid singular claim with hospice routine home care procedure code Z7100, for dates of service from January 1, 2016 – May 31, 2016, or revenue code 0651 for dates of service from June 1, 2016 – May 1, 2018:

  1. A provider has previously submitted a claim on date of service July 1, 2016, for hospice routine home care service revenue code 0651, which has been adjudicated and the provider has received reimbursement.

  2. Upon implementation on May 1, 2018, (revenue code 0650 for high rate, 0659 for low rate, 0552 for SIA), the provider wishes to be reimbursed for those new rate amounts for the previously paid claim.

  3. Using the steps and details found in the CIF Completion section in the Part 2 manual, the provider requests a void on the previous claim by checking Overpayment in the checkbox on the CIF and submitting the paid RAD with the CIF.

  4. The DHCS Fiscal Intermediary (FI) receives the CIF, voids the previous claim and the provider receives the voided RAD.

  5. Within 90 days, the provider submits the appeal with a voided RAD and corrected/updated claim with the new revenue codes to the DHCS FI for reprocessing.

    1. The provider indicates in the Remarks field (Box 80) that the previous claim was voided, along with the reason for the void and expectation to be reimbursed at the new routine home care rates.

    2. The appeal is submitted within 90 days of the submission date on the voided RAD.

  6. The reprocessing of the updated claim occurs and reimbursement finalizes, as appropriate, with the new rates.*

The following is an example series of events for submission of a mass void of many previously paid claims with hospice routine home care procedure code Z7100, for dates of service from January 1, 2016 – May 31, 2016, or revenue code 0651 for dates of service from June 1, 2016 – May 1, 2018:

  1. A provider previously submitted 100 claims for dates of service from January 1, 2016 – May 31, 2016, for hospice routine home care service procedure code Z7100, which have been adjudicated and the provider has received reimbursement.

  2. Upon implementation on May 1, 2018, (revenue code 0650 for high rate, 0659 for low rate, 0552 for SIA), the provider wishes to be reimbursed for the new rate amounts for the previously paid claims.

  3. The provider compiles all Claim Control Numbers (CCNs) and their NPI for each previously reimbursed claim and sends this list to HospiceEPC@conduent.com before July 1, 2018. At that time, CCNs will be submitted for a mass void. Providers should note that this process is subject to scheduling and may take up to six months for completion.

  4. A mass void occurs for all the submitted CCNs, and the provider receives the voided RADs.

  5. Within 90 days, the provider submits the appeal with a voided RAD and corrected/updated claim with the new revenue codes to the DHCS FI for reprocessing.

    1. The provider indicates in the Remarks field (Box 80) that the previous claim was voided, along with the reason for the void and expectation to be reimbursed at the new routine home care rates.

    2. The appeal is submitted within 90 days of the submission date on the voided RAD.

  6. The reprocessing of the updated claim occurs and reimbursement finalizes, as appropriate, with the new rates.*

*Disclaimer: During this CIF/resubmission process, once the original claim has been voided, the original reimbursement will be taken back. Providers should account for this until the reprocessed claim is adjudicated and the new reimbursement occurs, as appropriate.

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program aids (13); medi non hcp (2)
Audiology and Hearing Aids
Chronic Dialysis Clinics
Durable Medical Equipment
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
medi non hcp (2)
Clinics and Hospitals
General Medicine
hospic (7–9, 12); medi non hcp (2)
Hospice Care Program hospic (7–9, 12); hospic bil cd (1, 2); hospic ge (2, 4); medi non hcp (2)
Inpatient Services hospic (7–9, 12)
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2. Manual Updates: Online PDF RAD and Medi-Cal Financial Summary

General information about the new PDF RAD has been added to the Medi-Cal provider manual.

Providers can securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary from the Transactions tab of the Medi-Cal website home page.

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.

PDF RAD User Guide Reminder
The PDF RAD Web Portal User Guide is available on the Medi-Cal website. The user guide contains step-by-step instructions to help providers view and download the PDF version of their RAD. Providers may download the guide from the User Guides page of the Medi-Cal website.

 

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

No provider payments are made via PDF RADs. They are informational only.

835 Transactions
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). The form is located on the Forms page of the Medi-Cal website. 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.

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

Provider Manual(s) Page(s) Updated
Part 1 remit (1); remit and (3); remit elect (4)
Acupuncture
Adult Day Health Care Centers
AIDS Waiver Program
Audiology and Hearing Aids
Chiropractic
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Inpatient Services
Local Educational Agency
Long Term Care
Medical Transportation
Multipurpose Senior Services Program
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
remit adv (1)
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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 April 1, 2018
NDC Labeler Code Contracting Company's Name
00316 CROWN LABORATORIES, INC.
10599 INTERSECT ENT, INC.
24201 CUSTOPHARM, INC. DBA LEUCADIA PHARMA
66794 PIRAMAL CRITICAL CARE
69680 VITRUVIAS THERAPEUTICS, INC.
69794 ULTRAGENYX PHARMACEUTICAL INC.
70482 ADAMAS PHARMA LLC
71143 OPTINOSE US, INC.
71287 KITE PHARMA, INCORPORATED
71394 SPARK THERAPEUTICS, INC.
71399 AKRON PHARMA INC.
   
Terminations, effective April 1, 2018
NDC Labeler Code Contracting Company's Name
42192 ACELLA PHARMACEUTICALS, LLC
67546 ROMARK LABORATORIES

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 (4, 6–8, 16–20)
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4. National Correct Coding Initiative Quarterly Update for April 2018

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after April 1, 2018.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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5. May 2018 Medi-Cal Provider Seminar

The May Medi-Cal provider seminar is scheduled for May 15 – 16, 2018, at the Double Tree Hilton in Fresno, California. Providers can access a class schedule for the seminar by visiting the Provider Training web 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 (FI) for Medi-Cal 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 May 1, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After May 1, 2018, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 representative.

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

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6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

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

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