RA Messages for January 5, 2010
PHARMACY
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
at 1-800-648-0790.
PLEASE NOTE
THE FOLLOWING CHANGES TO APPENDIX A
DRUG
DOSE
STRGTH
FUL
EFF
NITROGLYCERIN
TAB SUBL
0.3MG OFF LMAC
12/14/2009
NITROGLYCERIN
TAB SUBL
0.4MG OFF LMAC
12/14/2009
ACETIC ACID/ALUMINUM ACETATE
OTIC DROPS
2% OFF
LMAC 12/17/2009
Detailed LMAC and FUL
changes are posted on
www.lamedicaid.com.
Please file
adjustments for claims that may have been incorrectly paid. Only those
products of the manufacturers which participate in the Federal Rebate
Program will be covered by the Medicaid program. Participation may be
verified in Appendix C, available at
www.lamedicaid.com.
NURSING HOME
PROVIDERS
2010
Nursing Home Case-Mix Rate Training Workshop is scheduled for January
25, 2010 from 1:00 p.m.- 4:30 p.m. at the Department of Environmental
Quality, Galvez Building, Oliver Pollock Conference Room C111, 602 N.
Fifth Street, Baton Rouge, LA 70802.
This program has been designed to provide nursing facility personnel and
consultants an understanding of the Louisiana case-mix rate methodology,
case-mix calculations, fair rental value bed-buy back, private room
conversions, and the use of cost report data.
The training is appropriate for Cost Report Preparers, Accountants
(including Home Office Staff), CFO's, Controllers, Office Managers, and
Others involved in Case-Mix Rate Reviews. 4 CPE credits: Specialized
Knowledge & Applications. Submit registration by January 18, 2010. To
download the registration form, go to http://www.dhh.la.gov/offices/events.asp?ID=111&detail=7910
or contact Myers & Stauffer LC @ 1-800-374-6858.
ATTENTION
HOSPITAL PROVIDERS
Effective
December 1, 2009, Ambulatory Surgery is exempt from the 24 hour rule in
which outpatient services exceeding 24 hours in duration are deemed
inpatient. Ambulatory surgery (Revenue Code 490) and the other revenue
codes associated with the surgery may now be billed as outpatient
regardless of the duration of the outpatient stay.
Any questions should be directed to Provider Relations.
ATTENTION
PROFESSIONAL SERVICES ANESTHESIA PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS
Effective
with dates of service on or after August 4, 2009, the reimbursement
rates for anesthesia services that are performed under the professional
licensure of a physician (anesthesiologist or other specialty) are
reduced by 3.5% of the fee amounts on file as of August 3, 2009. An
emergency rule regarding these reductions was published in the August
20, 2009, issue of the Louisiana Register.
Providers
will begin seeing these reductions on the RA of January 5, 2010. Claims
for date of service August 4, 2009, that were adjudicated prior to
January 5, 2010, will be systematically adjusted and no action is
required by providers. Providers should monitor future RAs for updates
regarding these adjustments. Notification will be made via remittance
advice message when the recycle occurs. Effective for dates of service
on or after November 20, 2009, maternity-related anesthesia services and
anesthesia services rendered to recipients under the age of 16 shall be
exempt from the August 4, 2009, rate reduction on anesthesia services
performed by a physician (anesthesiologist or other specialty). An
emergency rule was published regarding this amendment in the November
20, 2009, issue of the Louisiana Register.
PHARMACY
PROVIDERS
Pharmacy
Providers are advised that the new Louisiana MAC (Maximum Allowable
Cost) prices will be implemented January 8, 2010.