Medi-Cal Update

Hospice Care Program | May 2018 | Bulletin 524

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1. A New Way to Subscribe – Contact Medi-Cal Subscription Service Representatives

Medi-Cal is committed to keeping you up-to-date on the latest Medi-Cal news and policy updates.

The Medi-Cal Subscription Service (MCSS) is a free service that provides subscribers with personalized email notifications for urgent, high-impact announcements and monthly news/policy updates as they post to the Medi-Cal website.

Providers can now contact MCSS representatives directly at MCSSCalifornia@conduent.com to subscribe and for assistance with managing subscriptions. Subscribing is simple and free!

If you have not yet subscribed to MCSS, Medi-Cal encourages you to utilize one of the following two methods to subscribe.

To subscribe by email:

  1. Download the linked MCSS Subscriber Form

  2. Enter your name, email address, ZIP code and subscriber type in the appropriate fields

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

  4. Attach your completed form to an email and send to MCSSCalifornia@conduent.com

To subscribe online:

  1. Go to the MCSS Subscriber Form page on the Medi-Cal website

  2. Enter your email address and ZIP code, and select a subscriber type from the drop-down menu

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

  4. Click “Subscribe Now” at the bottom of the page

After the form has been received, 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, visit the MCSS Help page.

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2. 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 appealfor 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 an appeal with the voided RADs and corrected/updated claims 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
Hospice Care Program hospic bil ex (6–8)
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3. Valid Revenue Codes for Outpatient Services

For dates of service on or after January 1, 2019, a four-digit revenue code must be included on outpatient claims billed on paper UB-04 claim forms (Box 42) or ANSI 837I transactions for electronic billing (FL42; reference ASC X12N 837 v.5010 Loop 2400 Segment SV201).

A revenue code identifies specific accommodations, ancillary services, or unique billing calculations or arrangements. As defined by the National Uniform Billing Committee (NUBC) and required by the HIPAA, services covered in an outpatient setting require a valid four-digit revenue code to accompany the CPT and HCPCS national procedure code(s).

Outpatient claims with dates of service on or after January 1, 2019, that are submitted on paper UB-04 claim forms or ANSI 837I transactions with missing, incomplete, or invalid revenue codes will be denied.

Providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 for claims assistance.

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4. June 2018 Medi-Cal Provider Training Webinars

Beginning June 5, 2018, and continuing throughout the month of June, Medi-Cal providers may participate in provider training webinars:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have Internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

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5. 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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