RA Messages for March 14, 2000

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 MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:

PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX C:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

NOTICE TO KIDMED PROVIDERS

THERE IS A TYPOGRAPHICAL ERROR IN THE KIDMED MANUAL ON PAGE VIII-7.  UNDER EPSDT CONSULTATION CODE X0180 IT SAYS THAT A NURSE ASSISTANT CAN PERFORM THIS PROCEDURE.  THIS IS INCORRECT.  THAT SHOULD READ PHYSICIAN ASSISTANT, NURSE ASSISTANTS CANNOT PERFORM KIDMED NURSE CONSULTATIONS.  PLEASE MAKE NOTE OF THIS IN YOUR KIDMED MANUALS.

KIDMED

SCHOOL BOARDS MAY NOT BILL MEDICAID FOR THE ADMINISTRATION OF MEDICATION.  THIS DUTY IS WITHIN THE SCOPE OF THE SCHOOL BOARD'S RESPONSIBILITY.  NEITHER X0187, NOR 992211 SHOULD BE BILLED FOR MEDICATION ADMINISTRATION BY A SCHOOL NURSE.

HOSPITALS

SPLIT-BILLING REQUIREMENTS DUE TO EMERGENCY RULES REDUCING PER DIEMS EFFECTIVE MARCH 1, 2000 AND MARCH 8, 2000. ALL LONG TERM CARE HOSPITALS AND ALL PRIVATE AND PUBLIC PSYCHIATRIC HOSPITALS, INCLUDING PSYCHIATRIC UNITS WITHIN PRIVATE ACUTE CARE  HOSPITALS, WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE EFFECTIVE MARCH 1, 2000 (ONE-TIME ONLY). ALSO, ALL ACUTE CARE HOSPITALS (EXCEPT CHARITY HOSPITALS) WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE EFFECTIVE MARCH 8, 2000 (ONE-TIME ONLY).

ALL PROVIDERS

CONTRACT ARRANGEMENTS WITH PRIVATE INSURANCE

SOME PROVIDERS CONTRACT WITH PRIVATE INSURANCE COMPANIES TO PROVIDE SERVICES AT A REDUCED RATE.  POLICY HAS BEEN CLARIFIED REGARDING THESE SITUATIONS.  MEDICAID IS INTENDED TO MAKE PAYMENTS ONLY WHERE THERE IS A RECIPIENT OBLIGATION TO PAY.  THIS MEANS THAT THE DISCOUNTS ESTABLISHED WITH THE INSURANCE COMPANY MUST BE PASSED ALONG TO MEDICAID, AND MEDICAID IS NOT RESPONSIBLE FOR PAYING ON CHARGES OVER AND ABOVE THE CONTRACTED RATE.  PLEASE MAKE SURE YOUR MEDICAID BILLING METHOD INCLUDES THESE DISCOUNTS.

ALL PROVIDERS

WE HAVE BEGIN RECEIVING CALLS FROM PROVIDERS ASKING IF IT IS ACCEPTABLE TO REFUSE TO ACCEPT MEDICAID WHEN A PATIENT HAS BOTH MEDICARE AND MEDICAID.  A PROVIDER MAY NOT REFUSE TO ACCEPT MEDICAID IN THESE CIRCUMSTANCES.  HCFA, THROUGH AN OBRA 89 PROVISION, MANDATES ACCEPTANCE OF ASSIGNMENT UNDER MEDICARE FOR INDIVIDUALS WHO ARE ELIGIBLE FOR BOTH MEDICARE AND MEDICAID.  ADDITIONALLY, SOME, IF NOT ALL MEDICARE PROVIDER  MANUALS ALSO INDICATE THAT IF A MEDICARE BENEFICIARY IS ALSO A RECIPIENT OF MEDICAID, THE PROVIDER MUST ACCEPT ASSIGNMENT ON CLAIMS FOR SERVICES RENDERED, REGARDLESS OF THE PROVIDER'S PARTICIPATION STATUS IN THE MEDICARE PROGRAM.