March 12, 2021 MaineCare Updates

In this message: 

• Attention Providers of  Sections 14, 45, and 90 Services: Addition of Coverage for Home International Normalized Ratio (INR) Testing and Monitoring Services, CR 100796 
• Interpreter Services Clarification for Providers

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Attention Providers of  Sections 14, 45, and 90 Services: Addition of Coverage for Home International Normalized Ratio (INR) Testing and Monitoring Services, CR 100796  

Effective January 1, 2021, codes G0248, G0249, and G0250 have been added to MaineCare Benefits Manual, Chapter II, Sections 14 (Advanced Practice Registered Nursing Services), 45 (Hospital Services), and 90 (Physician Services) contracts for at-home INR testing and monitoring services for MaineCare members who require anticoagulation therapy for the following covered diagnoses:   

• Mechanical heart valve(s)  
• Chronic atrial fibrillation 
• Venous thromboembolism   

See the table below for the codes, descriptions, and rates.  

At-Home INR Testing and Monitoring Service Information
Codes	Official Code Description	MaineCare Rate
G0248	Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient's ability to perform testing and report results	$59.50
G0249	Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests	$53.18
G0250	Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests	$6.48

 Please contact your Provider Relations Specialist with questions.    

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Interpreter Services Clarification for MaineCare Providers

MaineCare providers may select an interpreter for members, parents, or guardians who need interpreter services. MaineCare reimburses interpreter services for MaineCare Members.

The resources below can help connect you with interpreter services that are currently available in Maine. These lists may not be comprehensive and do not indicate MaineCare’s preference for how providers choose an interpreter. Providers may use their discretion when hiring an interpreter.  

See the following webpages for interpreter referrals:

• 211 Maine
• Department of Education

When requesting reimbursement from MaineCare for interpreter services:

• The MaineCare member’s primary language must be one other than English.
• MaineCare will only provide reimbursement for the time that interpreters provide the interpreting service to the member or guardian during the MaineCare-covered appointment.
• Providers can submit a request for reimbursement on the same day the interpreter service occurred.
• Providers must submit a copy of the invoice with the claim for interpreter services delivered via telehealth or by phone.
• Interpreters cannot provide interpreter services for their own family members (e.g. husbands, wives, fathers, mothers, children, in-laws, or co-habitants).
• MaineCare will not reimburse transportation time.
• MaineCare Non-Emergency Transportation (NET) brokers will not provide reimbursement for interpreters who transport patients to their appointments.

See the MaineCare Benefits Manual, Chapter I, Section 1, Subsection 1.06-2 for more detail about reimbursement for interpreter services.

Documentation Requirements

When billing MaineCare for interpreter services, you must include the following information in the MaineCare member’s record to receive reimbursement:

• The MaineCare member’s or guardian’s primary language
• A statement verifying the interpreter’s qualifications
• The interpreter’s appropriate certification and licensure
• A signed Code of Ethics document from the interpreter - Providers must document that interpreters have provided evidence of having read and signed a Code of Ethics document. Please see the MaineCare Benefits Manual, Chapter I, Section I, Appendix 1, for an example of an acceptable Code of Ethics document.
• Date, time, and duration of the interpreter service
• The cost of performing the interpreter service
• An invoice from the interpreter
• Language interpreter used to communicate with the member

Interpreter’s Appropriate Certification and Licensure

Providers of interpreter services for the deaf or hard of hearing must be licensed by the Maine Department of Professional and Financial Regulation as one of the following: 

• Certified Interpreter/Transliterate
• Certified Deaf Interpreter
• Limited Interpreter/Transliterate
• Limited Deaf Interpreter

Questions?

Please contact your Provider Relations Specialist with questions.

Providers or members may call the MaineCare Program Integrity Unit if they suspect abuse of service or fraud, at 207-287-4660 or 1-866-348-1129 (fraud hotline).

To access the Interpreter Serivces Clarication for Providers in the future, please see the Provider Resources webpage.