Medi-Cal Update

Therapies | May 2017 | Bulletin 500

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2. Providers to Report PPCs Using DHCS Secure Online Portal

Effective June 1, 2017, the Department of Health Care Services (DHCS) will no longer accept paper forms for reporting provider-preventable conditions (PPCs). DHCS began accepting online reporting of PPCs for Medi-Cal on April 3, 2017. The development of secure online submission is in response to provider requests to make PPC reporting easier. This new online process replaces the paper Medi-Cal Provider-Preventable Conditions (PPC) Reporting Form (DHCS 7107). The secure online reporting portal is available on the Instructions for online reporting of PPCs Web page of the DHCS website.

Providers must report health care-acquired conditions (HCACs) when they occur in an acute hospital inpatient setting, and report other provider-preventable conditions (OPPCs) when they occur in any health care setting, according to state law in Welfare and Institutions Code (W&I Code), Section 14131.11, as well as the Code of Federal Regulations (CFR) Title 42, Sections 434, 447 and 438. Providers must report PPCs for any Medi-Cal recipient when any PPC occurs that did not exist prior to the provider initiating treatment, even if the provider will not seek Medi-Cal reimbursement to treat the PPC.

More information about PPC reporting requirements, PPC definitions and mandatory payment adjustments is available on the Medi-Cal Guidance on Reporting Provider-Preventable Conditions Web page of the DHCS website. Providers may email questions about the new PPC process to PPCHCAC@dhcs.ca.gov.

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3. 2017 ICD-10-CM Diagnosis Code Annual Update

A previously published NewsFlash article titled “Additional Information: 2017 ICD-10-CM Diagnosis Code Update” notified providers that, with the 2017 annual ICD-10-CM update, a number of diagnosis codes have been expanded for greater detail. The Medi-Cal Provider Manuals and the Family PACT Policies, Procedures and Billing Instructions manual are now updated to reflect these expansions. Deactivated codes have been removed.

Providers should use the new, expanded codes when billing for dates of service on or after October 1, 2016.

Provider Manual(s) Page(s) Updated
Acupuncture
Audiology and Hearing Aids
Chiropractic
Medical Transportation
Orthotics and Prosthetics
Therapies
cms comp (14)
Chronic Dialysis Clinics inject drug i-m (10); path chem (2–4, 6, 8–10)
Clinics and Hospitals chemo drug p-z (17); ev woman (16, 17); incont (8); inject drug i-m (10); medne neu (6); minor (3); ophthal (9); ophthal cd (2, 4, 6–8); path chem (2–4, 6, 8–10); path micro (7); preg early (3, 8, 9, 11–13, 15, 16); prescript (5); radi dia ult (1); radi nuc (1); spec (2); surg eye (7, 11, 12)
Durable Medical Equipment cms comp (14); incont (8)
Family PACT ben fam rel (8, 10, 13); ben grid (13–15); lab (12–14, 26, 28)
General Medicine chemo drug p-z (17); cms comp (14); ev woman (16, 17); incont (8); inject drug i-m (10); medne neu (6); minor (3); ophthal (9); ophthal cd (2, 4, 6–8); path chem (2–4, 6, 8–10); path micro (7); preg early (3, 8, 9, 11–13, 15, 16); prescript (5); radi dia ult (1); radi nuc (1); spec (2); surg eye (7, 11, 12)
Inpatient Services minor (3)
Long Term Care incont (8)
Obstetrics cms comp (14); ev woman (16, 17); inject drug i-m (10); minor (3); path chem (2–4, 6, 8–10); path micro (7); preg early (3, 8, 9, 11–13, 15, 16); radi dia ult (1); radi nuc (1)
Pharmacy cms comp (14); incont (8); inject drug i-m (10)
Psychological Services cms comp (14); spec (2)
Rehabilitation Clinics inject drug i-m (10)
Vision Care minor (3); pro serv cd (2–4, 6, 7)
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4. Updated Drugs and Nutritional Products List Requiring SAR for CCS and GHPP

Effective retroactively for dates of service on or after July 1, 2015, Beneprotein powder is added to the pharmacy list of drugs and nutritional products requiring a separate Service Authorization Request (SAR) for the California Children's Services (CCS) program and the Genetically Handicapped Persons Program (GHPP).

Effective retroactively for dates of service on or after June 1, 2016, Sofosbuvir/Velpatasvir is added to the pharmacy list of drugs and nutritional products requiring a separate SAR for CCS and GHPP.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (8); genetic (9)
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5. June 2017 Medi-Cal Provider Training Webinars

Beginning June 1, 2017, 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 and Education page of the Medi-Cal website.

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