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July 2016
In this issue:
Health System Transformation
- Medicaid Electronic Health Records (EHR) Incentive Program
Other provider updates
- 1915(i) service benefits and authorizations
- Use modifier H9 when billing for jail diversion services to OHP members
- New email address for submitting hospice notifications to APD
- Updates to Medicare-Medicaid Billing Invoice (OHP 505)
- Updated Out of Hospital Birth Reimbursement Guide
- Codes 27096, 77051 and 77052 now closed for payment
- Register for 2016 Oregon Flu Summit & More: August 23, 2016
- Save the date: 33rd Annual Oregon Rural Health Conference
- Reminder: Monthly payment recovery for OHP newborn claims
Medicaid Electronic Health Records (EHR) Incentive Program
Year 2015 - eligible professionals:
- Eligible professionals can now submit their Program Year 2015 Meaningful Use attestations until August 31, 2016.
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New documentation requirements for program year 2015 - Please include the
following documents as part of your attestation:
- Copy of Meaningful Use Summary Report;
- Security Risk Assessment (SRA). HealthIT.gov offers an SRA tool to help providers complete this assessment;
- Inventory list;
- Deficiencies noted and the corrective action plan(s), including target dates for implementation;
- Documentation of who completed the SRA; and
- If you used the program Year 2014 Flexibility Rule, documentation that you upgraded to a 2014 certified system.
Year 2016 updates for eligible professionals:
- Eligible professionals can now submit their Program Year 2016 Adopt, Implement or Upgrade and Meaningful Use (First Year) attestations until March 31, 2017.
- Program year 2016 is the last year to begin the program (coming in under AIU or MU Payment Year 1). Eligible professionals can receive an incentive payment for adopting, implementing or upgrading certified EHR technology in their first year of participation.
What is the Medicaid EHR Incentive Program?
The program provides federal incentives, up to $63,750 paid over six years to certain eligible providers who adopt, implement, upgrade or achieve meaningful use of certified electronic health record technology (CEHRT).
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Eligible professionals must choose to participate in either the Medicare or Medicaid EHR Incentive Program.
- Most but not all of the eligible hospitals in Oregon meet the federal requirements to participate in both the Medicare and Medicaid EHR Incentive Programs.
- Hospitals that receive payments under both programs must first attest to Medicare and then attest for a payment through Medicaid.
- Once payments begin in Medicare, hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.
For more information
1915(i) service benefits and authorizations
1915(i) Home- and Community-Based benefit services are available to help individuals with mental health conditions live independently and transition from licensed residential care. These services are for Medicaid-eligible members who, due to their mental health experiences, need daily assistance with at least two activities of daily living that take at least one hour daily to provide.
There are two types of 1915(i) benefit services:
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Home-based habilitation services help individuals establish the skills necessary to live successfully and comfortably in a home or community-based setting.These services can include recovery support, assistance in obtaining transportation,skill development on home maintenance, money management and various educational supports for other daily activities.
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Behavioral habilitation services help individuals attain or maintain their maximum level of independence. These services can include behavior support, training and education or activity therapy.
To request these services, providers need to submit requests to KEPRO using the new 1915(i) eligibility request form along with supporting clinical documentation.
Questions?
To learn more about 1915(i) services, visit the KEPRO website. If you still have questions, contact KEPRO:
- Phone: 1-844-658-1729
- Fax: 1-844-673-8034
- Email: OR1915i@kepro.com
- Mail: KEPRO, PO Box 2960, Tualatin, OR 97062
Use modifier H9 when billing for jail diversion services to OHP members
Does your treatment agency provide jail diversion services to OHP members? If so,
please include modifier H9 – Court-ordered when billing for these services (for service
dates on or after April 1, 2016).
Using the H9 modifier will help OHA better identify the types of services used to help prevent OHP members from entering or returning to jail or the state hospital.
To learn more, please read our recent letter to behavioral health providers.
New email address for submitting hospice notifications to APD
The Aging and People with Disabilities (APD) Medicare Modernization Act Hotline (also
known as the MMA Unit) has a new email address for submitting the Hospice Notification
for Nursing Facility Residents form (OHP 525).
Instead of faxing these forms, hospice providers can now send them via secure email to
MMA.525@dhsoha.state.or.us.
If you have problems with the DHS/OHA secure email website, or do not know how to send
a secure email, you can also email MMA.525@dhsoha.state.or.us and ask for a secure
email to use.
Updates to Medicare-Medicaid Billing Invoice (OHP 505)
We have updated the Medicare-Medicaid Billing Invoice (OHP 505) to remove DMAP
references and remove the shading on the Supplemental Information lines. Removing the
shading will help us process these claims faster.
If you make your own version of this form, or make changes to it in any way, we will return the claim for you to resubmit on the correct form.
Did you know you can submit Medicare-Medicaid claims using the Provider Web Portal? Visit our Provider Web Portal page to learn more.
Updated Out of Hospital Birth Reimbursement Guide
OHA has posted the updated Out of Hospital Birth Reimbursement Guide (revised July
2016). Changes are marked by bold bookmarks.
- This has been reformatted and reorganized for easier reading.
- It includes more detail about required documentation, and a new required form for all documentation submissions to OHA (the OHA Provider Documentation Checklist).
Codes 27096, 77051 and 77052 now closed for payment
The following procedure codes are now closed for payment, as recommended by Health Evidence Review Commission guidelines.
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27096 - Injection procedure for sacroiliac joint, anesthetic/steroid, withimage guidance (fluoroscopy or CT) including arthrography when performed
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77051 - Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (list separately in addition to code for primary procedure)
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77052 - Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure).
Register for 2016 Oregon Flu Summit & More: August 23, 2016
The 2016 Oregon Flu Summit & More has a strong focus on influenza, but topics will include more vaccines and vaccine preventable illnesses.
Objectives for the 2016 Oregon Flu Summit & More include:
- Share practice- and evidence-based strategies for improving immunization coverage across the continuum of care.
- Provide up-to-date information and guidance for all stakeholders involved in prevention, control, and treatment of vaccine preventable illnesses.
- Explore uses of communication and outreach techniques to reach target populations.
- Identify vaccination-related challenges and solutions..
Save the date: 33rd Annual Oregon Rural Health Conference
This conference continues to be the largest gathering in Oregon dedicated to presenting the most innovative approaches to addressing today’s health care issues.
Bringing together providers, administrators, patients, activists, policy makers and others who are concerned about health care in rural Oregon, it is an opportunity to exchange ideas, information, and expertise among individuals and organizations engaged in or concerned with rural health care issues.
Reminder: Monthly payment recovery for OHP newborn claims
Every month, OHA recovers a small number of payments made in the preceding month for services to newborns who are now enrolled in a CCO.
- Once the birth is reported, we enroll children born to CCO members in the mother’s plan.
- However, depending on when the birth is reported to us, this process may take three or more weeks to complete.
To avoid future recoveries for newborn services:
What you will see on the paper remittance advice (RA), electronic remittance advice (ERA) or PWP:
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On the paper RA: Adjusted claims will have an ICN beginning with “52”. The “Detail EOBs” for these ICNs will list Explanation of Benefits (EOB) code EOB 0090 – Service is covered by a managed care plan. Claim must be billed to the appropriate managed care plan.
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On the ERA or PWP: The ERA should list these adjustments as overpayment recoveries. PWP will show the adjustment ICN as a denied claim. In both ERA and PWP, the reason for recovery will be Adjustment Reason Code 24 - Charges are covered under a capitation agreement/managed care plan.
To learn more about recovery of overpayments or appeals, please see Oregon Administrative Rules 410-120-1397(7), 410-120-1560 and 410-120-1580 in the General Rules guidelines.
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