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August 2016
In this issue:
Health System Transformation
- Medicaid Electronic Health Records (EHR) Incentive Program
- Comprehensive Primary Care Plus (CPC+) – call for provider participation: applications due Sept. 15, 2016
Other provider updates
- Use the new two-page Oregon Medicaid Trading Partner Agreement (TPA) for all electronic data interchange (EDI) registration needsse modifier H9 when billing for jail diversion services to OHP members
- Corrections for January and July 2016 Prioritized Lists
- Save the date: 33rd Annual Oregon Rural Health Conference
- Reminder: Verify all health care resources for patients
- Reminder: Accepted versions of the OHP 505 and MSC 3970
- Reminder: Monthly payment recovery for OHP newborn claims
Medicaid Electronic Health Records (EHR) Incentive Program
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 (AIU) )or achieve meaningful use (MU) 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.
Year 2015 - eligible professionals:
- Eligible professionals can now submit their Program Year 2015 Meaningful Use attestations until Aug. 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.
For more information
Comprehensive Primary Care Plus (CPC+) – Call for provider participation: applications due Sept. 15, 2016
The Centers for Medicare & Medicaid Services (CMS) has selected Oregon to implement the CPC+ model, which brings Medicare, commercial insurers and coordinated care organizations (CCOs) together under a common model that aligns payment methods, engages patients and allows for better coordination.
- We strongly recommend all eligible providers apply for this unique opportunity by the deadline: Sept. 15, 2016.
- Please see OHA’s CPC+ Announcement for more information about CPC+ and the provider application process. Feel free to distribute this information widely.
- You can also learn more by viewing the August 11 webinar about CPC+ provider participation.
Use the new two-page Oregon Medicaid Trading Partner Agreement (TPA) for all electronic data interchange (EDI) registration needs
The new Trading Partner Agreement for Electronic Health Care Transactions (OHA 2080) replaces all previous OHA EDI registration and update forms. Use this form to:
- Register as an Oregon Medicaid trading partner
- Identify your EDI submitter
- Select the EDI transactions you want to exchange with OHA
Also use this form to notify OHA of any changes to:
- Authorized signers, transactions and EDI submitter
- Any related contact information
- Your Oregon Medicaid ID, business name or Tax ID
To learn more, view our updated self-paced guide about the TPA form.
If you have recently submitted older EDI registration forms to OHA (such as the DMAP 2080, 2081, or 2082 forms), you do not need to resubmit using the new form. Submit a new OHA 2080 form the next time you have new changes to make.
Corrections for January and July 2016 Prioritized List
On Aug. 18, 2016, the Health Evidence Review Commission (HERC) released the following corrections:
For the 7/1/2016 List:
- Remove M43.6 Torticollis from line 407 CONDITIONS OF THE BACK AND SPINE
- Move ICD-10-CM E51.2 Wernicke's encephalopathy from line 205 to line 206 CHRONIC ORGANIC MENTAL DISORDERS INCLUDING DEMENTIAS.
- Add ICD-10-CM Q06.8 Other specified congenital malformations of spinal cord to line 351 CONDITIONS OF THE BACK AND SPINE WITH URGENT SURGICAL INDICATIONS.
- Remove CPT 63200 Laminectomy, with release of tethered spinal cord, lumbar from line 366 SCOLIOSIS.
For the 1/1/2016 List:
- Move ICD-10-CM E51.2 Wernicke's encephalopathy from line 205 to line 206 CHRONIC ORGANIC MENTAL DISORDERS INCLUDING DEMENTIAS.
Questions?
Email HERC.Info@state.or.us.
Also try HERC’s Searchable List tool and sign up to get HERC email updates to keep informed about Prioritized List changes.
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.
The Rural Health Conference brings together providers, administrators, patients, activists, policy makers and others who are concerned about health care in rural Oregon. I provides a unique opportunity to exchange ideas, information, and expertise among individuals and organizations engaged in or concerned with rural health care issues. OHA Director Lynne Saxton will be the plenary speaker for this event.
Reminder: Verify all health care resources for patients
Please make sure to verify all insurance resources for your patients before providing services. This will help you bill the correct payer first.
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Ask all patients about all health care resources. This includes their CCO, Medicare coverage and any related Medicare plans, as well as private health insurance.
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Report private health insurance (also known as third-party liability [TPL]) at www.reportTPL.org.
- Bill TPL first.
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Coordinate benefits with Medicare and Medicaid (OHP). OHA pays only for Oregon Health Plan (OHP) services that the CCO or TPL do not cover. The OHP eligibility and enrollment fact sheet explains how to know which services are covered by OHA and which are covered by the CCO.
If any other payer pays for an OHP-covered service at or above OHA’s maximum allowable rate, OHA considers the service paid in full. You cannot bill the patient for the covered service.
Reminder: Use accepted versions of the OHP 505 and MSC 3970 Coversheet to expedite payment
Please only use OHA’s versions of the OHP 505 (Medicare-Medicaid Billing Invoice) and EDMS Coversheet (MSC 3970). If you make your own versions of these forms, we will return them to you.
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:
- Please report births as soon as possible using the Newborn Notification Form. Allow two to three weeks for processing.
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Verify the newborn’s CCO enrollment using Provider Web Portal, Automated Voice Response or Electronic Data Interchange.
- Once you have verified the newborn’s CCO enrollment, bill the CCO.
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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