MPCA Billing Network Conference Call Summary

September 25, 2017 Call Summary

Dental Claims Processing

·  Centers report of unsuccessful submissions

Ø  Dental APM Codes

§  Nicole noted Dental Codes can be found on Clinic Institutional Billing Fee Screen via MDHHS Provider Page

§  Any codes listed in the code group Clinic-Dental APM table, should be paying the PPS rate with the additional APM rate being reimbursed on the same claim at the time of claim adjudication.

§  Dental claims follow the PPS rate logic, PPS rates apply to all clinic and clinic services

§  If PPS rate is not reported at the D claim line, MDHHS will pay up to the rate reported on the D line, this issue is being resolved and will be rectified by year end.

§  PPS rate will be made up in cost settlement if not corrected prior to. Payment of the lesser than will be resolved

§  Please review: Policy MSA 17-10 under section D; Nicole will send this over to policy for more clarification; will also review MOA regarding payments

·  Centers request copy of 2014 MOA to be sent with list of visit allowances

§  Nicole will assist in advocating with the MHPs on claims processing and send inquiries to the contract managers once more details are received

Ø  When there are three D (Dental) codes on the same DOS; if the D codes count as an encounter, they will be paid with the exception of some services, for example x-rays which will pay at $0

§  Example: Cleaning/X-ray same DOS; cleaning at $100, clinic will receive PPS rate

Ø  Dentures being paid incorrectly

§  Nicole notes a defect has been found and MDHHS is currently aware of the issue. Centers are receiving denials and MDHHS plans to correct this issue by year end; once corrected, centers will be paid appropriately. MDHHS will pay PPS rate x visit count (7)

Other Dental Topics

1.  Is there a list that notes how many visits are allowed?

  1. Nicole has an internal document only, as of now there is not one available; MPCA and MDHHS will review the document for clarity and share with the Network once verified

2.  For upper and lower dentures, will the center capture 7 visits or 14?

  1. Nicole will verify the limits on units and follow up to confirm

3.  Center reports receiving PPS rates but there are discrepancies; encounters with more than one extraction, all lines paid at PPS rate

  1. Nicole requested examples for review, and will follow up with centers once this is confirmed;

4.  Full Mouth Debridement

  1. A center acknowledged receiving payments but have also received take back letters; will send examples to Charmaine to forward to Nicole for review.

5.  Centers request list of codes to be added to the multiple visit table that will note the number of visits allowed for that code

Medical/Behavioral Health

1.  BH: Attending must be an MD or DO; centers must be sure the attending is an MD or DO and the provider is reported in the rendering field. SW, Psychiatrist or Professional Counselor should not be reported in the attending field. Supervising is not required, the main requirement is that your attending is an MD or DO and provider; this rule also applies to the PT; if the PT provider is an MD, he/she can be their own attending. See policy 1.5-44

2.  Medical and BH same day: you will only need one attending.

Billing Provider: Center

Attending: MD/DO and PA/NP, PT

Rendering: SW, Professional Counselor, Psychiatrist

This rule applies as follows: CMS provides the definition of an Attending Provider so this would apply to all UB billing, even HMO billing.

Medical/Behavioral Health

3.  Nicole will send over directions for adding the rendering to the UB (paper); there is definitely an area to add this information within CHAMPS

4.  Managed Care Plans: It is suggest that centers first touch base with MHPs and include in the communications for tracking. Once contact is made, please send over details to include center NPI and Nicole will forward to contract managers

5.  Influenza Vaccines: will not be paid as stand-alone; Nicole suggested contacting MSA Policy and she will also discuss this with Kristie P.

  1. Adult vaccines were also discussed, Nicole will follow up on this as well. Centers also noted that reimbursement is received via cost report.

6.  When 2 G Codes with EM are reported, if vaccines are given do we apply modifier 25?

  1. Follow same modifier rules, there will not be an additional payment, you would receive PPS rate for EM
  2. Nurse visits would not count as face to face, submit claim as $0 for reporting

7.  $66.16 is being paid no matter the EM, this is a defect and being resolved

  1. For straight Caid, MDHHS will pay PPS rate, MHP will pay $66.16
  2. Centers are requesting something in writing from each payer regarding what rate will be paid, there are different answers being received.

8.  Vaccine billing with Nurse Visit

  1. Claim goes out on UB, no G codes associated, the claims would be paid at $0; Nicole will get clarification. Center would not receive admin fees

Other:

·  A recording of this Teleconference is available until October 25, 2017, to access:

Ø  Call Toll Free 1-888-203-1112

Ø  Replay Code 337726288

·  Charmaine and Nicole will create a schedule for the monthly Institutional Billing Call which will be shared with the Networks once confirmed

·  An FAQ on Dental and Institutional Billing will be available on MPCAs Billing and Finance Page by October 6, 2017 as a reference

Next Billing Network Call:

·  October 10, 2017 at 1pm. To join, dial 1-866-453-5550, passcode: 7478807#. Please send agenda items in advance to Charmaine Femster at .

Please send billing questions to MPCA by emailing Charmaine Femster at . You can ask questions directly to your peers in the Billing Managers Network through the listserv at .