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Industry Trends – August 2016

August 28th, 2016

INDUSTRY TRENDS

Horizon NJ Health

  • Claims billed to Horizon NJ Health still have processing issues and hospitals are realizing increased receivables.   One hospital reported that they were told by TriZetto that their systems will not be fully updated until August 2016. To date, there does not seem to be material improvement. Issues include but are not limited to:
    • Claims are priced incorrectly.
    • Claims are returned if not completed on the red and white form. This includes some, but not all claims sent electronically.
    • Phone contacts take up to 45 minutes.
    • Claims deny for no authorization though the authorizations were obtained.
  • NJHA asked the Department of Business and Insurance to monitor. Providers who need assistance should contact Gregory Papazian via email at gregory_papazian@horizonblue.com. Mr. Papazian is responsible for all provider relations areas. You are encouraged to send this as a special request and NOT as a routine project list. If it is a routine “project” many hospitals noted it can take months to resolve.

 

Medicare

  • The August 30, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • Medicare Change Requests:
  • MM9603 will be implemented on January 3, 2017. Medicare is imposing the use of the JW modifier for any claims associated with discarded drug or biologicals not administered to any patient. This must also be documented in the patient’s medical record. (See Attachment)
    • SE1615 informs providers that Medicare will cover Zika Virus testing. (See Attachment)
    • MM9740 will be implemented on January 3, 2017. The Common Working File (CWF) is adding an auto-search capability that will eliminate the need to go through multiple hosts to obtain eligibility information.HFMA Update

Federal Issues: The Fiscal Year (FY) 2017 Proposed Hospital Outpatient Prospective Payment System (OPPS) Rule was released Wednesday, July 6, 2016.  Comments are due to CMS September 6, 2016.

  • Payment Update: CMS proposes to utilize the 2.8% hospital market basket increase for OPPS. Reductions will be taken as mandated by the Affordable Care Act (ACA):
    • 0.5% adjustment for multi-factor productivity and
    • an additional 0.75% adjustment.
    • this results in a net market basket of 1.55%.
  • ASC service payments are updated for inflation by the percentage increase in the Consumer Price Index for urban consumers (CPI-U), which is proposed at 1.7% for calendar year (CY) 2017.       In addition, there is a 0.5% multifactor productivity adjustment resulting in a net CPI-U update factor for CY 2017 of 1.2%.
  • Section 603 of the Bi-Partisan Budget Act:
    • CMS included information in the rule regarding implementation of Section 603 of the Bipartisan Budget Act of 2015.       Section 603 states that services furnished in off-campus provider based departments (PBD), (excluding dedicated emergency department services that began billing on or after November 2, 2015) will no longer be paid under the OPPS and will be paid under Part B payment systems beginning January 1, 2017.
    • Beginning in 2017, the rule proposes the payment be based on the physician fee schedule for site-neutral rates for most services furnished in a new off-campus PBD. The payment, which would be at the “non-facility” PFS rate, is for physicians only; CMS proposes no payment be made directly to the hospital by Medicare.
    • Existing off-campus PBD (before November 2, 2015) that expand their clinical services are subject to the site-neutral rate as would any facility that relocates after November 2, 2015.       An off-campus PBD that existed prior to November 2, 2015 and undergoes a change of ownership after that date will be exempt from the site-neutral rate only if the new owner accepts the existing Medicare provider agreement from the prior owner.
  • Electronic Health Record (EHR) Incentive Program:
    • In the rule, CMS recommends a 90-day reporting period for 2016, versus the full year.
    • They also propose to reduce the requirement for patients to view, download and transmit their information from the current 5% obligation down to a minimum of one patient.

 

State Issues The State Fiscal Year (SFY) 2017 Budget was finalized June 30, 2016:

  • Charity Care
    • The final SFY 2017 budget contains $200 million less for charity care, reducing in the pool from $502 million to $302 million. This is the result of a $150 million reduction in the Governor’s proposed budget and an additional $50 million cut that Governor Christie put forward as revenues lagged.
    • The Legislature stood with NJHA in rejecting this additional $50 million cut, but Governor Christie used the line-item veto to implement the reduction.
    • The charity care distribution formula uses the 2004 statute, pro-rating down to account for the reduced amount of charity care funding in the SFY 2017 budget. The distribution formula is the same as the one released in the Governor’s proposed budget in February.
    • The state is reimbursing hospitals with the highest relative charity care burden at 96% of what Medicaid would have paid for those patients (96 cents on the dollar) based on calendar year 2014 documented charity care. The formula removes any upward cap over the prior year that would have limited any charity care subsidy increase to hospitals.
  • Graduate Medical Education (GME) will see an increase of $60.7 million, raising that pool from $127.3 million to $188 million for the state’s 42 teaching hospitals.
    • The $188 million FY 2017 GME funding will be distributed using 2014 CMS Medicaid cost reports.
    • This year’s formula requires facilities receiving GME funding to report to the Commissioner of Health the number of physicians who plan to remain in New Jersey.
  • The Delivery System Reform Incentive Payment (DSRIP) fund will remain at last year’s level of $166.6 million.
  • The Mental Health Subsidy Fund will hold at the same level as last year at $24.7 million.

 

Industry Trends – July 2016

August 5th, 2016

INDUSTRY TRENDS

 

Medicare

  • The July 20, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • MLN Matters article SE1604 summarizes available Medicare coverage for substance abuse services. (See Attachment)
  • April 2016: MM9533 informs providers about the Comprehensive Care for Joint Replacement (CJR) education. The new CJR model is established to promote quality and financial accountability for episodes of care surrounding Lower-Extremity Joint Replacement (LEJR) or reattachment. Joint replacement procedures are currently paid under DRG 469 or 470.       Under the new guidelines, the episode will include the LEJR procedure, inpatient stay and all related care under Medicare Parts A and B within the 90 days after discharge.

 

Medicaid

  • Medicaid released a newsletter advising providers that on or about July 1, 2016, DMAHS will terminate enrollment of NJ Family Care fee for service providers who have not completed a re-enrollment application.
  • May 2016: Permedion audits are enforcing the regulation that the admit order must be the same day of admission. This causes denials when a baby is born on one day and the pediatrician does not write the admit order until the next day.
  • Maternity claims for the mothers are overpaid as they are grouping them into a surgical DRG. Medicaid is advising hospitals to “hold” them until the recap occurs. There is no timeframe for these recoupments.

 

 

Aetna Better Health

Several hospitals have reported discrepancies with Aetna Better Health payments. Primary accounts are not paying at the contracted rates and secondary accounts have been erroneously declined as having no authorizations.

 

HFMA Patient Financial Services: Pertinent Info

  • Long Term Acute Care (LTAC) Payment Rules
  • LTAC patient claims must be filed by acute hospitals within a specific time frame. On October 1, 2016 there will be a payment policy change. The new rule changes may negatively impact payments. LTAC’s may receive the lower IPPS rate instead of the LTAC PPS rate.
  • Two Midnight Rule Audit Pause
    • There is detail on the CMS website noting CMS found inconsistencies in the audit process.
    • Review all denied claims since October 2015 to ensure decisions are in line with the current policy. Re-review these accounts before you appeal.
    • Communicate with Livanta BEFORE you appeal to determine where your hospital stands.
    • Education has been provided to some hospitals, but not all. The algorithm of how to proceed is on Livanta’s website.
  • RAC: On June 2, 2016 a new timeline in the active procurement process was received.
    • May 16, 2016:       the last day an auditor can send an ADR
    • July 29, 2016:        the last day you can be notified of an improper payment
    • August 28, 2016:  the last day for discussion
    • October 1, 2016:   the last day the RAC can send claim adjustment files to the MAC’s.
    • If the RAC does not meet one of the deadlines, the account review “should be” closed, however this is not yet certain.
  • HNJH TriZetto Trading Partner Systems issues continue:
    • Claims are still not processing correctly. When the roll out began in April 2016, over 13,000 claims incorrectly denied for missing the primary payer EOB. Some still remain unprocessed.
    • In May, approximately 45,000 claims were received at HNJH’s office after being forwarded there from their former, London, KY office. These accounts are said to be processed, but follow up is needed at many facilities.
    • Their systems will not be fully updated until August.
    • Claims are not accepted and are returned if not submitted on a red and white UB04. Most hospitals can easily create a black and white UB04 for submission, but preparing a red and white UB04 is inefficient for many.
        • Phone calls take up to 45 minutes to answer.
        • Claims deny for no authorization, despite a valid authorization obtained and on file.
      • Locals processing through Horizon Blue Cross are recapping payments stating patients were not covered on the dates of service, even though Hospitals verified benefits upon admission.   NY Medicaid
      •  

      February 2016: The Affordable Care Act mandates that all Medicaid providers must be revalidated every 5 years.  Revalidation is to be completed by March 2016.  (See Attachment)

       

      Property Tax/Not-for-Profit Tax Status

      March 2016: During the lame duck session, the Hospital Community Service Contribution Bill was passed through both the Senate and the Assembly.

      • Non-Profit Hospitals with For-Profit operations would have to make Community Service Contributions directly to their municipalities. The payment formula is set at $2.50 per day for each acute care hospital bed and $250 per day for each facility providing Satellite Emergency Care.       It would generate roughly $20 million in revenue per year.
      • Municipal payments would be dedicated to property tax relief and public safety (police, fire and emergency services).       Five percent of the payments would be sent to the county where the hospital is located.
      • Voluntary contributions by the hospitals would be deducted from the community service payments and any hospital that is losing money could apply for an exemption from the payments.
      • Not-for-Profit hospitals would retain their tax-exempt status.

      On January 19, 2016, Governor Chris Christie used a pocket veto to stop the bill, effectively vetoing the Hospital Community Service Contribution Bill. There was no opportunity for an overriding vote.

      • A new bill will now have to be reintroduced in the regular legislative session and pass through the Senate and Assembly again.
      • NJHA is in contact with the Governor’s office to determine the reasoning behind the pocket veto in case modifications need to be made to a future version of a bill.

       

      Veteran’s Administration Claims

      The Department of Veteran Affairs continues to have a material backlog processing claims, now stated to be eight months. Emergency care is covered, but no additional services are.  Once patients are stabilized, they should be transferred.

       

Industry Trends – June 2016

July 13th, 2016

INDUSTRY TRENDS

Horizon NJ Health

New Jersey Hospital Association hosted a Web seminar on May 16, 2016 with Horizon NJ Health (HNJH). Attached is the information reviewed during the seminar.  The HNJH representatives advised:

  • Ensure that provider’s Clearinghouse is accepted by TriZetto Trading Partner Systems.
  • Please check your claims submitted just before and just after the transition to TriZetto.
  • Paper claims must not have any handwriting nor be on a black and white UB04.
  • Approximately 13,000 claims incorrectly denied for missing primary payer’s EOB. These claims are expected to be reprocessed after the system fix is implemented by May 20, 2016.
  • Approximately 45,000 claims were received at HNJH’s new office after being forwarded by the US Postal Service from their former London, KY office. Processing the backlog of these claims is expected to be resolved in two to three weeks.
  • Claims denied by HNJH did not include a denial reason. This system issue was corrected May 13, 2016. Claims are being reprocessed with documented denial reasons.
  • Any issues with Navinet access should be directed to Navinet. Obtain reference/ticket number from Navinet to provide to HNJH if needed.
  • Specific issues or questions should be submitted to HNJH at CareAffiliates@horizonblue.com. Allow 48-72 hours for responses.

 

 

 

 

Medicare

  • The June 20, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • MLN Matters article SE1604 summarizes available Medicare coverage for substance abuse services. (See Attachment)
  • Effective July 1, 2016, Medicare is imposing the use of the JW modifier for any claims associated with discarded drug or biologicals not administered to any patient. This must also be documented in the patient’s medical record.

 

Medicaid

Recent Permedion audits are enforcing the regulation that the admit order must be the same day of admission. This is causing denials when a baby is born on one day and the pediatrician does not write the admit order until the next day.

 

American Association of Healthcare Administrative Management

The House of Representatives passed H.R. 5273, the Hospitals Improvement Care Act (HIP-C), which helps hospitals improve patient care by promoting greater access and choices and improve the quality of healthcare (see attached release from AAHAM).

Industry Trends – May 2016

May 27th, 2016

INDUSTRY TRENDS

Horizon NJ Health

New Jersey Hospital Association hosted a Web seminar on May 16, 2016 with Horizon NJ Health (HNJH). Attached is the information reviewed during the seminar.  The HNJH representatives advised:

  • Ensure that provider’s Clearinghouse is accepted by TriZetto Trading Partner Systems.
  • Paper claims must not have any handwriting nor be on a black and white UB04.
  • Approximately 13,000 claims incorrectly denied for missing primary payer’s EOB. These claims are expected to be reprocessed after the system fix is implemented by May 20, 2016.
  • Approximately 45,000 claims were received at HNJH’s new office after being forwarded by the US Postal Service from their former London, KY office. Processing the backlog of these claims is expected to be resolved in two to three weeks.
  • Claims denied by HNJH did not include a denial reason. This system issue was corrected May 13, 2016. Claims are being reprocessed with documented denial reasons.
  • Any issues with Navinet access should be directed to Navinet. Obtain reference/ticket number from Navinet to provide to HNJH if needed.
  • Specific issues or questions should be submitted to HNJH at CareAffiliates@horizonblue.com. Allow 48-72 hours for responses.

 

 

Medicare

  • The May 23, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • The listing of the “Most Frequently Asked Questions” is attached.
  • MLN Matters article SE1604 summarizes available Medicare coverage for substance abuse services. (See Attachment)

Industry Trends – April 2016

April 12th, 2016

INDUSTRY TRENDS

Topics Discussed at the March 31, 2016 AAHAM Meeting:

Amerihealth

  • As of October 1, 2015, payments will be issued once a week. The new EOB shows individual breakdown of how claims were processed.
  • As of January 1, 2016, radiation therapy authorizations are obtained through Evercore.
  • Fee schedules for CPT codes can be checked via Navinet.

 

Aetna

  • Precertification requests should be submitted electronically. Requests received are directed to Aetna nurses for review.
  • Claims submitted electronically process quicker.
  • Identification cards can be accessed via Navinet.
  • Precertification information request forms can be accessed via Navinet.

 

Horizon NJ Health

Horizon NJ Health has changed their mailing address. The new address is:  P.O. Box 24078, Newark New Jersey, 07101

 

Medicare

The April 13, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.

Medicare Change Requests

  • MM9549 informs providers of changes and billing instructions for implant HCPCs codes C1822 and C1820, and drugs, biological and radiopharmaceuticals with outpatient prospective payment system (OPPS) pass through statuses. The change request also advises providers that laboratory HCPCs codes G0477-G0483 are denying in error. (See Attachment)
  • MM9563 informs providers of new waived tests.       (See Attachment)

Medicaid

  • Inpatient claims containing certain ICD10 codes are not mapping to the expected DRG. Medicaid is working on an updated version of the software.       Claims processing with edit code 480 should be submitted to the Hospital Reimbursement Unit at P.O. Box 712, Trenton, NJ 08625.       (See Attachment)
  • Claims submitted to Medicaid that deny with edit codes 086 (transportation claims only), 083, 800 or 380 should be submitted to the Hospital Reimbursement Unit at P.O. Box 712, Trenton, NJ       08625. The claims should be submitted with a cover letter, name and phone number of contact person and page of the voucher showing the edit posted. (See Attachment)

Claims that deny with edit code 257, 259 or 086 (except transportation claims) should be submitted to the Office of the Medical Director. The request to update the procedure file should be submitted with clinical documentation to justify the change.  (See Attachment)

Industry Trends – March 2016

March 8th, 2016

INDUSTRY TRENDS

Medicare

  • NJHA will look into the delays hospitals are experiencing with their applications for additional DDE logins. The 90-day delay is negatively impacting many.
  • The March 7, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • Medicare Change Requests
  • SE1605 informs providers of the requirements for revalidation. Providers can check http://go.cms.gov/MedicareRevalidation to find out if they are due for revalidation. (See Attachment)
  • MM9533 informs providers about the Comprehensive Care for Joint Replacement (CJR) education. The new CJR model is established to promote quality and financial accountability for episodes of care surrounding Lower-Extremity Joint Replacement (LEJR) or reattachment. Joint replacement procedures are currently paid under DRG 469 or 470. Under the new guidelines, the episode will include the LEJR procedure, inpatient stay and all related care under Medicare Parts A and B within the 90 days after discharge. (See Attachment)

 

           

NJ HFMA PFS Update

Property Tax/Not-for-Profit Tax Status

During the lame duck session, the Hospital Community Service Contribution Bill was passed through both the Senate and the Assembly.

  • Non-Profit Hospitals with For-Profit operations would have to make Community Service Contributions directly to their municipalities. The payment formula is set at $2.50 per day for each acute care hospital bed and $250 per day for each facility providing Satellite Emergency Care.       It would generate roughly $20 million in revenue per year.
  • Municipal payments would be dedicated to property tax relief and public safety (police, fire and emergency services).       Five percent of the payments would be sent to the county where the hospital is located.
  • Voluntary contributions by the hospitals would be deducted from the community service payments and any hospital that is losing money could apply for an exemption from the payments.
  • Not-for-Profit hospitals would retain their tax-exempt status.

On January 19, 2016, Governor Chris Christie used a pocket veto to stop the bill, effectively vetoing the Hospital Community Service Contribution Bill. There was no opportunity for an overriding vote.

  • A new bill will now have to be reintroduced in the regular legislative session and pass through the Senate and Assembly again.
  • NJHA is in contact with the Governor’s office to determine the reasoning behind the pocket veto in case modifications need to be made to a future version of a bill.

 

State of the State Address

  • On January 12, 2016, Governor Christie delivered the State of the State Address. The budget address was Tuesday, February 16, 2016.
  • He made an announcement of a commitment of an increase of $100 million to expand access and services for mental health and substance abuse patients.
  • Governor Christie also announced an increase in Medicaid rates to three Medicaid accountable care organizations in the state that have identified coordinated efforts to treat patients with both mental and physical health issues.
  • NJHA will attend stakeholder meetings this month to gather specific details on these proposals.

Industry Trends – February 2016

February 24th, 2016

INDUSTRY TRENDS      

February 24, 2016

 

Medicare

  • NJHA will look into the delays hospitals are experiencing with their applications for additional DDE logins. The 90-day delay is negatively impacting many.
  • The February 23, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • Medicare Change Requests
  • MM9515 informs providers of the new waived clinical lab tests. (See Attachment)
  • SE1128 (revised) reminds providers that they may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for balance billing. The QMB program is a State Medicaid benefit that covers Medicare deductibles, coinsurance and copayments. Medicare providers may not balance bill QMB recipients. (See Attachment)

 

 

NJ HFMA PFS Update

Property Tax/Not-for-Profit Tax Status

During the lame duck session, the Hospital Community Service contribution Bill was passed through both the Senate and the Assembly.

  • Non-Profit Hospitals with For-Profit operations would have to make Community Service Contributions directly to their municipalities. The payment formula is set at $2.50 per day for each acute care hospital bed and $250 per day for each facility providing Satellite Emergency Care.       It would generate roughly $20 million in revenue per year.
  • Municipal payments would be dedicated to property tax relief and public safety (police, fire and emergency services).       Five percent of the payments would be sent to the county where the hospital is located.
  • Voluntary contributions by the hospitals would be deducted from the community service payments and any hospital that is losing money could apply for an exemption from the payments.
  • Not-for-Profit hospitals would retain their tax-exempt status.

On January 19, 2016, Governor Chris Christie used a pocket veto to stop the bill, effectively vetoing the Hospital Community Service Contribution Bill. There was no opportunity for an overriding vote.

  • A new bill will now have to be reintroduced in the regular legislative session and pass through the Senate and Assembly again.
  • NJHA is in contact with the Governor’s office to determine the reasoning behind the pocket veto in case modifications need to be made to a future version of a bill.

 

State of the State Address

  • On January 12, 2016, Governor Christie delivered the State of the State Address. The budget address will be Tuesday, February 16, 2016.
  • He made an announcement of a commitment of an increase of $100 million to expand access and services for mental health and substance abuse patients.
  • Governor Christie also announced an increase in Medicaid rates to three Medicaid accountable care organizations in the state that have identified coordinated efforts to treat patients with both mental and physical health issues.
  • NJHA will attend stakeholder meetings this month to gather specific details on these proposals.

 

Other NJ Legislation to Watch

    • Nurse staff ratio: nothing was passed during lame duck but it is possible it will be introduced during this legislative session. NJHA is watching closely as Hospitals could find the bill’s compliance to be very costly. It may not be possible to find the number of registered nurses needed to comply with the set ratios.
  • Paid Sick Leave
  • Minimum wage increase to $15

Industry Trends – January 2016

February 12th, 2016

Medicare

  • The January 19, 2016 “Open Claims Issues” is attached with the dates for the scheduled fixes.
  • Medicare issued information about the correct reporting of MSP claims. Claims received on or after February 16, 2016 that do not include the correct MSP type code will reject. (See Attachment)
  • Medicare Change Requests
  • MM9448 informs providers of the physical, speech and occupational therapy caps for 2016. (See Attachment)
  • MM9357 informs providers of the new influenza virus vaccine code. (See Attachment)

 

 

 State of the State

Governor Christie’s 2016 State of the State Address announced a historic financial commitment of more than $100 million to increase access to care for mental health and substance abuse.

Industry Trends – December 2015

December 16th, 2015

Industry Trends

Medicaid

The following topics were discussed at the November 12, 2015 AAHAM meeting:

  • The e-mail address for correspondence is MAHS.hospitalissues@DHS.state.nj.us. All correspondence should have a cover letter describing the issue along with the sender’s name and phone number.
  • Karen Chester (Regional Staff Nurse) reviews:
  • Claims denying for edit codes 083 (surgical code missing), 480 (DRG change) or duplicates.
  • Psych claims denied by both the HMO Medicaid and Medicaid. Attachments should include a cover letter, with contact information, physician progress notes and detailed EOB from the HMO. After review, if approved, the claim will be sent to Medicaid for special batching.
  • Secondary Medicaid social hold claims should be submitted with a cover letter, physician progress notes, and a detailed EOB from the primary payer. After review, claim will be sent to Abby Molnar (Administrative Analyst) for processing.
  • Jessica Feehan (Director of Office Reimbursement):
  • HMO Hotline phone number (800-701-0720) for HMO Medicaid issues was provided. Participants at the meeting stated that the HMO Hotline was not helpful. Ms. Feehan suggested sending HMO Medicaid issues to the hospital issues e-mail address for assistance in obtaining information.
  • Billing questions and/or denials should be directed to Medicaid (800-776-6334). If no resolution, ask to speak with Edna (lead) or Sheila Sand (supervisor).

 

Medicare

The following topics were discussed at the November 12, 2015 AAHAM meeting:

  • The 2016 deductible is $1,288, coinsurance is $322/day, and LTR is $644/day.
  • The December 1, 2015 “Open Claims Issues” is attached with the dates for scheduled fixes.
  • On October 30, 2015, Medicare released a “Two Midnight Rule” fact sheet updating the changes in the ruling regarding inpatient admissions. Under certain situations, Medicare will cover stays less than two midnights on a case by case basis. (See Attachment)

 

 

 

INDUSTRY TRENDS

December 16, 2015

Page 2

 

 

  • Medicare representative, Diane Hess, explained that claims with an “inpatient only” procedure should be billed as a one day inpatient stay. Ms. Hess advised of the importance of documentation by the physicians that the service was medically necessary. See PFS conversation started by Lynn Kahn at Hackettstown.
  • Attached are the directions on obtaining Medicare provider enrollment status.
  • Attached are instructions for the proper use of Modifier 59
  • Medicare Change Requests:
    • SE1411 provides clarification of patient discharge status codes and hospital transfer policies. (See Attachment)
    • MM9317 provides information for the usage of modifier 53 for incomplete colonoscopies. (See Attachment)
    • MM9078 informs providers the specific situations that single and dual chamber permanent cardiac pacemakers will be covered. (See attachment)

 

Horizon NJ Health

At the November 12, 2015 AAHAM meeting, Michele Merchant (Hospital Relations) discussed Horizon’s new product, OMNIA. OMNIA does not provide out of state benefits.  The Horizon portal will provide additional OMNIA information.

 

 

 

Industry Trends- November 2015

November 16th, 2015

INDUSTRY TRENDS

Medicaid

  • Medicaid issued an alert informing providers of billing procedures for claims with service dates on or after October 1, 2015.       (See Attachment)
  • Newsletter Volume 24 – No 10 provides updated information for NJ FamilyCare and Medicare for Psychiatric Emergency Rehabilitation Services coverage and reimbursement. (See Attachment)

Medicare

  • The November 10, 2015 “Open Claims Issues” is attached with the dates for scheduled fixes.
  • Medicare change request 9078 informs providers the specific situations that single and dual chamber permanent cardiac pacemakers will be covered. (See attachment)
  • On October 30, 2015, Medicare released a “Two Midnight Rule” fact sheet updating the changes in the ruling regarding inpatient admissions. Under certain situations, Medicare will cover stays less than two midnights on a case by case basis. (See Attachment)

Attached are the directions on obtaining Medicare provider enrollment status.