BILLING UPDATES MAY 2016

By Jackie Lucas, Billing Manager

MEDICAID

ePACES TO ADD NEW FEATURE EFFECTIVE JUNE 1, 2016

In an effort to make user data more secure and to improve system performance, eMedNY will be installing a new feature that will impact ePACES users when signing on to the ePACES application. This new feature, commonly called CAPTCHA, is a program that can distinguish whether the user attempting to sign on is a human or a computer.

EFFECTIVE June 1, 2016: When users attempt to sign on to ePACES from the eMedNY website, the user will be asked to verify that he/she is a person and not a computer by selecting specific images. Once the user has successfully verified the correct images, he/she will be allowed to sign into the ePACES account. If the incorrect images are selected, the user will be asked to verify another set of images before being allowed access to ePACES.

This new feature is widely utilized by other secure websites. Many people are familiar with it and have probably had to use it to gain access to those secure websites. The NYS Department of Health is adding this feature to help secure your data, and to prevent unauthorized computer-automated access to ePACES that could adversely impact ePACES performance.

IMPORTANT NOTE: All users will need to have installed Internet Explorer (IE) version 10 or greater or any alternative browsers including Google Chrome, Mozilla Firefox, or Apple Safari. IE versions 9 and below will NOT be supported. Please be sure to coordinate with your IT department to upgrade your internet browser, if necessary, before the effective date shown above.

Questions about ePACES can be directed to the eMedNY Call Center at 800-343-9000.

 INDEPENDENT HEALTH

NATIONAL DRUG CODES (NDC) REQUIRED FOR ALL PHYSICIAN ADMINISTERED MEDICATION

In accordance with the New York State Medicaid Program, Independent Health requires a valid 11-digit NDC number on claims when billing for all physician administered drugs that use J codes for its state products (MediSource, Child Health Plus, Essential Plan). The New York State Medicaid Program addressed this requirement in its April 2015 update (link below).

To participate properly in New York State’s All Payer Database, Independent Health is expanding this reporting requirement to all other fully-insured lines of business (Commercial plans and Medicare Managed Care plans) for dates of service beginning June 1, 2016.

The NDC is maintained by the U.S. Food and Drug Administration (FDA) and contains identifying information regarding the labeler/manufacturer, strength, dosage form and formulation of a drug product. The code is located on drug invoices, inserts and/or product packages.

Beginning for dates of service June 1, 2016, Independent Health will require the following when providers submit claims for physician administered drugs that use J-codes (J0000-J9999):

  • Valid NDC number
  • Quantity and measurement

Please note, Independent Health will deny claims submitted without this information for dates of service June 1, 2016 or after.

The use of NDC codes follows similar efforts for improved specificity in health care operations, similar to the recent move to ICD-10 coding.

Link to April 2015 Medicaid Update Addressing NDC Requirement:
https://www.health.ny.gov/health_care/medicaid/program/update/2015/2015-04.htm#rep

Link to New York State All Payer Database Program:
https://www.health.ny.gov/technology/all_payer_database

If you have questions, please contact Independent Health’s Provider Services Department at providerservice@servicing.independenthealth.com or call (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

PF WILL BE CONTACTING YOU FOR YOUR UPDATED NDC CODES

UNIVERA

NEW ESSENTIAL PLAN FOR UNINSURED PATIENTS AND THEIR FAMILIES

You may have patients who are currently uninsured – or who could potentially lose their health insurance coverage this coming year as a result of loss of employment or a change in benefits.

Per Univera, the Essential Plan, a new health plan for 2016, costs much less than what other health plans offer but at the same essential benefits. Those who qualify can enroll any time of the year.

Plans for as low as $0 or $20 per month are available to eligible individuals who meet household size and income guidelines. The Essential Plan has NO deductible and covers the same services covered by other quality insurance plans:

  • office visits (including specialists) and ordered tests
  • prescription drugs
  • inpatient and outpatient care
  • free preventive care (routine exams and screenings)

Important Note: Essential Plan is only available in the eight counties of our Western New York service area (Erie, Niagara, Cattaraugus, Chautauqua, Allegany, Orleans, Wyoming and Genesee), and only practitioners located within those counties are eligible to provide services to Essential Plan members. Uninsured patients can go online or call Univera for help determining if they qualify. The Essential Plan is only available

through the New York State of Health Marketplace, but they offer an online calculator at ChooseUnivera.com to help determine eligibility.

MEDICARE

ROUTINE TETANUS VACCINES

For claims received on or after 6/1/2016, tetanus vaccines will be subject to denial when a routine non-covered diagnosis code is linked to the CPT code. Providers must be aware that if the tetanus vaccine is medically necessary, the appropriate ICD-10 diagnosis code must be linked to the CPT code. For routine vaccines, which are expected to be denied, procedure codes including the administration need to be submitted with modifier GY for correct denial.

NGS is aware that not all providers have been using modifier GY to obtain a denial for supplemental insurance processing. Claims paid in error with a routine non-covered diagnosis code will be adjusted for refunds.

NON-COVERED ICD-10 DIAGNOSIS CODES

National Government Services (NGS) has seen an increase in claims for CPT 90471/90472 using ICD-10 code Z23 (Encounter for immunization), that were paid even though the provider was expecting the service to deny.

NGS advised that effective for claims received 1/1/2016 with dates of service 10/1/2015 and after, claims submitted with a combination of non-covered routine diagnosis codes and payable diagnosis codes would be considered for payment. Providers that submit claims with the intent of denial for supplemental insurance will no longer be able to submit a routine diagnosis for denial unless all of the reported diagnosis codes are routine non-covered. A combination of the routine diagnosis and the use of the GY modifier will be required for denial.

For Billing questions, please contact Jackie Lucas at 716-348-3923 or jackiel@pracfirst.com.

COMPLIANCE UPDATES – APRIL 2016

OCR LAUNCHES PHASE 2 OF HIPAA AUDIT PROGRAM

As part of its continued efforts to assess compliance with the HIPAA Privacy, Security and Breach Notification Rules, the HHS Office for Civil Rights (OCR) has begun its next phase of audits of covered entities and their business associates.

The audit process begins with verification of an entity’s address and contact information. This is handled through an e-mail sent to covered entities (CE) and business associates (BA) requesting that their contact information be provided to OCR in a timely manner. Once verification has been received, a pre-audit questionnaire will be transmitted to gather data from the CE. OCR will ask that the covered entity identify their business associates. They are encouraging covered entities to prepare a list of each business associate with their contact information, so they are able to respond to this request. The data that is gathered will be used along with other information to create a potential audit subject pool.

If a CE or BA does not respond to OCR’s request for verification or their pre-audit questionnaire, OCR will use publically available information about the entity to create its audit subject pool. Therefore, if no response is received, the entity may still be selected for an audit or be subjected to a compliance review.

Please check your junk or spam e-mail for any e-mails from OCR. As your business associate, please notify Becky Amann at Practicefirst, should you receive any e-mails from the OCR regarding a Phase 2 audit. This will allow us to watch for any e-mails from OCR as well.

Additional information regarding Phase 2 of the HIPAA Audit Program is available at: http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/index.html

For Compliance questions, please contact Becky Amann at 716-348-3902 or beckya@pracfirst.com

BILLING UPDATES – APRIL 2016

By Jacqueline Lucas, Billing Manager

MANDATORY ELECTRONIC PRESCRIBING BECAME EFFECTIVE March 27, 2016

As you know, effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances is now required in New York State. In order to process Electronic Prescriptions for Controlled Substances (EPCS), a prescriber must have selected and be utilizing a certified electronic prescribing computer application that meets all federal requirements. This application had to be registered by the practitioner with the NYS Dept. of Health, Bureau of Narcotic Enforcement (BNE).

UNITED HEALTHCARE (UHC) COMMUNITY PLAN – HARP

Beginning July 1, 2016 UHC Community Plan will start offering a Health and Recovery Plan (HARP). This is a new Medicaid plan benefit for members with significant behavioral health needs.  Any provider that is currently participating in UHC Community Plan will automatically participate in the HARP plan.  However, if you wish to opt out of HARP you must notify UHC in writing by April 15, 2016. The mailing address is:

UnitedHealthcare PCDM
PCDM Fulfillment
780 Shiloh Rd
Plano TX 75074

If you have any questions regarding this new plan, please contact UHC at 866-362-3368

GENERAL COMMENTS

In the near future, I will reach out to you for a convenient time to meet with physicians and your office staff.  My goal is to enhance our current processes to ensure we provide the most comprehensive billing service for all.  Please feel free to contact me prior to our meeting for any questions you may have. I look forward to meeting you in person.

Jackie Lucas

For Billing questions, please contact Jackie Lucas at 716-348-3923 or jackiel@pracfirst.com.

HEALTH REPUBLIC UPDATE

As you know, Health Republic ceased operations effective November 30, 2015. Claims processing and payments ceased in early November.  Due to the non-payment of claims, we have adjusted the outstanding balances owed by Health Republic from your Accounts Receivable. We have a history of each unpaid encounter in case the government makes a determination to issue payments on these claims. The total amount of Health Republic adjustments will be reflected in your month-end reports for March.

If you would like information regarding these adjustments, please contact Becky Amann at 716-348-3902.