RA Messages for August 10, 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 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. 

ATTENTION PROFESSIONAL SERVICES AND KIDMED PROVIDERS
IMPLEMENTATION OF JANUARY 2010 RATE REDUCTIONS

The reimbursement rate reductions for professional services effective with date of service January 22, 2010, have been implemented. Providers will begin seeing these reductions on the RA of July 20, 2010. Refer to the Office of the State Register's website at http://doa.louisiana.gov/osr/ for published rules detailing these reductions. Providers should monitor the LA Medicaid website (www.lamedicaid.com) for updates to the Professional Services Fee Schedule to occur in the near future. A supplement to the fee schedule will also be posted detailing the procedure codes affected by the reductions. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.

ATTENTION ALL PROVIDERS

David Blanchard, Engineering Technician, formerly with DHH's Division of Engineering and Architectural Services, is now located within the Health Standards Section of DHH, located at 500 Laurel Street, Suite 100, Baton Rouge, LA 70802. His mailing address is: DHH - Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821, and his telephone number is 225-342-9029. Mr. Blanchard's duties and responsibilities remain unchanged.

ATTENTION RHC/FQHC PROVIDERS
SYSTEMATIC ADJUSTMENT OF CLAIMS FOR ADJUNCT SERVICES

RHC/FQHC providers were notified in April 2010 that the programming to allow for reimbursement of adjunct services was implemented with date of processing 04/19/2010. Claims submitted timely with a date of processing prior to 04/19/2010 that initially denied due to the adjunct services not being payable were systematically adjusted on the RAs of 6/29/2010, 7/13/2010 and 7/27/2010. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the reimbursement and adjustment of claims for adjunct services.

UPDATE ON 'CLAIMCHECK' DENIALS RELATED TO MODIFIER-51

The resolution to the modifier -51 issue necessitating that providers delay the resubmission of claims that received 'ClaimCheck' denials for errors 934 (Modifier 51 Required-ClaimCheck) and 938 (Modifier 51 Invalid-ClaimCheck) is close to completion. Testing of this update to the claims processing system is currently in progress and it is anticipated it will be complete in the next few weeks. To expedite proper payment for providers, when the update is complete, claims previously denied for these errors will be recycled. Providers will not need to take any action. Providers will be notified when the update is complete and provided with details of the recycle via notices on the Louisiana Medicaid website homepage at www.lamedicaid.com, under the 'ClaimCheck' icon on the website, as well as on their RA messages. For further questions related to this matter, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
UPDATE TO PRECERTIFICATION POLICY RELATED TO INPATIENT PHYSICIAN CLAIMS

Effective with date of service August 30, 2010, in conjunction with the updates to the precertification/length of stay criteria for all acute hospital stays, the claims processing edits have been updated related to physicians' inpatient services. Physician inpatient services will continue to be edited to assure that the inpatient hospitalization has been precertified/approved. When there is no approved precertification on file, the inpatient physician services will deny. For a description of exceptions related physician charges when hospital stays are not precertified, refer to the 2007 Professional Services Training manual, page 76. For further questions related to this matter, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION ALL PROVIDERS
IMPLEMENTATION OF AUG 1, 2010 RATE REDUCTIONS

After careful analysis of the state budget approved for fiscal year 2010 - 2011 by the Louisiana Legislature, the Department of Health and Hospitals (DHH) has developed a plan to manage a $168.1 million total budget reduction. This reduction equates to 4.6% of the enacted budget for the Medicaid Private Provider Program.

The state has published Emergency Rules which address these program reductions which can be found online at the Office of State Register's website at http://www.doa.louisiana.gov/OSR/osr.htm by clicking on the Emergency Rules tab on the left navigation bar of the homepage. Refer to the homepage of the LA Medicaid website (www.lamedicaid.com) for a summary of these rules and a link to the LA Register.

Providers will be notified when the new rates are loaded for each program. At that time, providers should reference the LA Medicaid website for the most current fees. Claims for dates of service after August 1, 2010 that are adjudicated prior to the system update will be systematically adjusted and no action is required by providers. Continue to monitor future RAs. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions and claim adjustments.

UPDATE REGARDING RATE REDUCTIONS AND CLAIMS ADJUSTMENTS FOR
PROFESSIONAL SERVICES PROVIDERS

In response to concerns received from professional service providers affected by retroactive claims adjustments for reductions put in place over the last year, weekly adjustments have been postponed effective July 27, 2010 until further notice.

These weekly claim adjustments were intended to reduce the financial impact of the cuts by spreading the recoupment over time. However, we do recognize that many providers would prefer a single recoupment for accounting purposes. Medicaid providers who prefer claim adjustments to be placed into a single week's checkwrite should notify Louisiana Medicaid by sending an email to medicaidprofessionalservices@la.gov, or by letter to:

Medicaid Professional Services
P.O. Box 91030
Baton Rouge, LA 70821

Correspondence should include the full name of the provider and Medicaid provider ID number, along with the full name, title, and contact information for the authorizing individual.

DHH would also like to take this opportunity to educate providers on the availability of electronic remittance advice. These may already be available to you through your billing agent. Providers may contact the EDI department at Molina regarding the 835 transaction (electronic RA) at 225-216-6303 or by email at *hipaaedi@unisys.com. 

DHH is continuing to explore options to reduce the impact of these adjustments. Providers should continue to monitor RAs and www.lamedicaid.com for updates.

ATTENTION FREE STANDING REHABILITATION CLINICS, OUTPATIENT
HOSPITAL REHABILITATION CENTERS AND HOME HEALTH PROVIDERS

It is no longer necessary to include the PA-02 form with Prior Authorization requests for physical, occupational or speech therapy to be provided in an out-patient facility or in the recipient's home as long as the following are included: a completed PA-01 form, a signed and dated prescription, and a dated therapist's evaluation or current progress notes which states the recipient's plan and lists the proposed goals. Effective with date of processing July 19, 2010, Molina will no longer deny requests for rehabilitation services due to no PA-02 form being submitted with the PA packet. All Prior Authorization requests must still include for processing the Therapist's Evaluation/ Progress Notes and the signed Physician's Prescription for services.

ATTENTION LABORATORY, RADIOLOGY, AND ASC (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF AUG 2010 REIMBURSEMENT RATE REDUCTIONS

The reimbursement rate reductions effective with dates of service on or after August 1, 2010 for laboratory, radiology, and ASC (Non-Hospital) have been loaded in the system. Providers should reference the "Fee Schedules" link on the homepage of the LA Medicaid website (www.lamedicaid.com) for the most current fees. These rate reductions will begin appearing on the RA of August 10, 2010. A systematic adjustment of claims will be unnecessary due to timely implementation. Contact the Provider Relations unit at 800-473-2783 or 225-924-5040 with questions concerning the rate reductions.

ATTENTION EHR PROVIDERS

If you are an Eligible Professional or a Hospital provider who would like to learn more about the EHR Incentive Program, go to www.lamedicaid.com and click on the 'EHR Incentives' link for information on the CMS training that will start on Tuesday, August 10, 2010.

REHAB CENTERS, AMBULANCE TRANSPORTATION, KIDMED SCREENING CLINICS,
DME, MOBILE X-RAY/RADIATION THERAPY CENTERS & OPTICAL SUPPLIERS

As detailed in the RA published in June/July 2010, there are claims that reimbursed referencing the wrong fee on file on the RA's of 5/25/10, 6/1/10, 6/8/10, and 6/15/10. The fees & programming logic were updated and claims that previously reimbursed erroneously will be systematically adjusted on the RA of 8/10/10. No action is required by providers. A detailed list of the codes impacted has been posted on www.lamedicaid.com. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning the error and adjustment of claims.