Medi-Cal Update

Inpatient Services | June 2015 | Bulletin 489

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1. Fiscal Year 2014 – 2015 Checkwrite Hold for Specific Provider Payments

Specific checkwrites scheduled for fiscal year 2014 – 2015 will be delayed until the start of fiscal year 2015 – 2016 as outlined below.

Checkwrite Hold for Fee-For-Service Provider Payments
Medi-Cal funded fee-for-service (FFS) programs scheduled for the warrant date of June 18, 2015, will be held until July 2, 2015. The checkwrites and payments to the following programs must be held during this time period:

Checkwrite Hold for Fee-For-Service Provider Payments Including State Only Programs
Medi-Cal funded FFS and state-funded programs scheduled for the warrant date of June 25, 2015, will be held until July 2, 2015. The checkwrites and payments to the following programs must be held during this time period:

Payments to the Every Woman Counts program will be excluded from all June checkwrite holds.

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2. Medi-Cal Checkwrite Schedule Update for Fiscal Year 2015 – 2016

Effective July 1, 2015, the checkwrite schedule is updated for fiscal year 2015 – 2016. The schedule reflects warrant release dates and Electronic Fund Transfer (EFT) dates of deposit for all programs, including the following:

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

Provider Manual(s) Page(s) Updated
Part 1 check (1)
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3. Upcoming Changes: HIPAA Code Conversion for Local Modifier ZS

An article that published in the April 2015 Medi-Cal Update announced that the effective date for the discontinuation of local modifier ZS would be July 1, 2015. Local modifier ZS designates both the professional (26) and technical (TC) components of a split-billable procedure on a claim or Treatment Authorization Request (TAR). However, in order to allow sufficient time for providers to make the necessary changes, the effective date for this policy is now August 1, 2015.

Effective for dates of service on or after August 1, 2015, the Department of Health Care Services (DHCS) is discontinuing local modifier ZS. Modifier ZS designates both the professional (26) and technical (TC) components of a split-billable procedure on a claim or Treatment Authorization Request (TAR). When billing for both the professional and technical components, a modifier is neither required nor allowed. This change is to continue HIPAA compliance efforts and to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.

Discontinuing local modifier ZS will affect claims and TARs for all split-billable procedures except for Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA) and Positron Emission Tomography (PET) procedures. See the relevant sections of the provider manual for details pertaining to the use of modifiers for MRI, MRA and PET procedures.

Note:

Effective for dates of service on or after August 1, 2015, providers who previously submitted claims or TARs for split-billable procedures using local modifier ZS are instructed to submit claims and TARs without a modifier.

Claim Completion
Except for MRI, MRA or PET procedures, providers will be instructed to use one of the following methods when submitting a claim for both the professional and technical components of split-billable procedures. See the relevant sections of the provider manual for details pertaining to the use of modifiers for MRI, MRA and PET procedures.

Physician Billing: The physician bills for both the professional and technical components and then reimburses the facility for the technical component, according to their mutual agreements.
The physician submits a CMS-1500 claim form with the procedure code on one claim line without a modifier in the Procedures, Services or Supplies/Modifier field (Box 24D).

Facility Billing: The facility bills for both the technical and professional components and then reimburses the physician for the professional component, according to their mutual agreements.
The facility submits a UB-04 claim form with the procedure code on one claim line without a modifier in the HCPCS/Rate/HIPPS Code field (Box 44).

TAR Completion
Except for MRI, MRA or PET procedures, providers will be instructed to use the following method when submitting a TAR for both the professional and technical components of split-billable procedures. See the relevant sections of the provider manual for details pertaining to the use of modifiers for MRI, MRA and PET procedures.

A provider submits the TAR with the procedure code on one service line without a modifier.

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4. Draft ICD-10 Code Release Manual Sections

In preparation for the implementation of ICD-10, all current provider manual sections on the Medi-Cal website referencing ICD-9 policy must be updated to reflect ICD-10 policy by the October 1, 2015 transition.

The Department of Health Care Services (DHCS) recognizes the transition will significantly impact the Medi-Cal program and providers. To prepare providers for the transition, DHCS has prepared Draft ICD-10 Code Release manual sections as a preview of the ICD-10 implementation impact to policy. These draft manual sections can be downloaded from the ICD-10 page of the Medi-Cal website. The Draft ICD-10 Code Release manual sections are not the final policy and may be subject to change.

The final policy changes from the implementation to ICD-10 will be published in future Medi-Cal and Family PACT Updates.

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5. Hospital PE: Applicant Criteria and Enrollment Period Updates

Effective for dates of service on or after June 22, 2015, applicants must meet the following updated criteria to qualify for Hospital Presumptive Eligibility (PE):

Additionally, individuals must be eligible in one of the Hospital PE groups below:

PE Enrollment Limitations
The number of PE enrollment periods an individual may receive are limited. PE enrollment periods received from any PE program listed below are limited to the past 12 months prior to applying for Medi-Cal and Hospital PE (except for PE for pregnant women). These PE enrollment periods are as indicated in the table below:

Medi-Cal PE Programs PE Enrollment Period Permitted within Past 12 Months
HPE - Pregnant Women No more than one PE period per pregnancy
HPE - Children Under 19 Years of Age No more than two PE periods within a 12 month period, starting with the effective date of the initial PE period
HPE - Parents and Caretaker Relatives No more than one PE period within a 12 month period, starting with the effective date of the initial PE period
HPE - Former Foster Care No more than one PE period within a 12 month period, starting with the effective date of the initial PE period
HPE - Adults No more than one PE period within a 12 month period, starting with the effective date of the initial PE period
Child Health and Disability Prevention (CHDP) Gateway No more than two PE periods within a 12 month period, starting with the effective date of the initial PE period
Breast and Cervical Cancer Treatment Program (BCCTP) No more than one PE period within a 12 month period, starting with the effective date of the initial PE period
PE for Pregnant Women No more than one PE period per pregnancy

Transaction Submission Process Update
The Hospital Presumptive Eligibility Medi-Cal Application (DHCS 7022) transaction submission process is scheduled to be updated in mid to late 2015. It is imperative that Hospital PE providers monitor the ACA Hospital PE Program page of the Medi-Cal website for future articles and materials regarding this anticipated update.

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

Provider Manual(s) Page(s) Updated
Inpatient Services hospital presum (1–8); hospital presum prov enroll (1)
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6. Hospital PE Program Provider Election Form and Agreement (DHCS 7012) Update

Effective June 22, 2015, the Hospital Presumptive Eligibility (PE) Program Provider Election Form and Agreement (DHCS 7012) has been updated. This form is to be completed by qualified providers, who are applying to become Hospital PE providers or requesting to add a clinic(s) to their existing DHCS 7012. The updated form can be found on the ACA Hospital Presumptive Eligibility (PE) Program page of the Medi-Cal website, under “Downloads.”

Instructions on completing the form are included with the form. Providers must review the provider requirements, submission checklist, and notification overview when completing the form. Providers must ensure that all sections are completed accurately.

Note:

The Hospital Presumptive Eligibility Medi-Cal Application (DHCS 7022) transaction submission process is scheduled to be updated in mid to late 2015. It is imperative that Hospital PE providers monitor the ACA Hospital PE Program page of the Medi-Cal website for future articles and materials regarding this anticipated update.

Additional information regarding the form may be found in the manual sections listed below.

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

Provider Manual(s) Page(s) Updated
Inpatient Services hospital presum (1–3); hospital presum prov (1–5); hospital presum prov enroll (1)
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7. Hospital PE Provider Intake Advisor Verification Form and FAQ Update

Effective June 22, 2015, the Hospital Presumptive Eligibility (PE) Provider Intake Advisor Verification Form (DHCS 7011) has been added to the ACA Hospital Presumptive Eligibility Program page of the Medi-Cal website, under “Downloads.”

This form is to be completed by providers enrolled in Hospital PE in order to permit contractors, third party vendors or sub-contractors to assist as Hospital PE Intake Advisors. Hospital PE Intake Advisors may assist applicants with the completion of the printed version of the Hospital Presumptive Eligibility (PE) Medi-Cal Application (DHCS 7022). However, Hospital PE Intake Advisors may not complete the online version of DHCS 7022 in the Hospital PE Application Web Portal or make eligibility determinations.

Section 3 of DHCS 7011 includes the guidelines for Hospital PE Intake Advisors to follow. Hospital PE providers must review and complete the form entirely and accurately.

Additional information regarding the form may be found in the manual sections listed below.

Additionally, the Hospital Presumptive Eligibility Program Frequently Asked Questions (FAQs) list has been updated to address common questions and concerns of Medi-Cal providers regarding the Hospital PE Program.

Note:

The Hospital Presumptive Eligibility Medi-Cal Application (DHCS 7022) transaction submission process is scheduled to be updated in mid to late 2015. It is imperative that Hospital PE providers monitor the ACA Hospital PE Program page of the Medi-Cal website for future articles and materials regarding this anticipated update.

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

Provider Manual(s) Page(s) Updated
Inpatient Services hospital presum (2); hospital presum prov enroll (1)
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8. Update: Inpatient Claims for Long-Acting Reversible Contraceptives

Effective for dates of service on or after July 1, 2015, general acute care hospitals as defined in Section 1250 of the Health & Safety Code may submit claims for the long-acting reversible contraceptive methods listed below on an outpatient claim, even when treatment is provided on an inpatient basis

HCPCS Code Contraceptive Method
J7300 Intrauterine copper contraceptive (Paragard)
J7301 Levonorgestrel-releasing intrauterine contraceptive system, (Skylark), 13.5 mg
J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Mirena)
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies (Implanon, Nexplanon)

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

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