Doh medicaid update april 2010 vol. 26 no. 6

The Department will annually re-examine all-payer surgical volumes and modify the list of hospitals and ambulatory surgery centers with which Medicaid will contract for such surgeries accordingly. Please contact the Division of Quality and Evaluation at Most Medicaid beneficiaries residing in Chenango, Delaware, and Franklin counties now have the option to enroll in Medicaid Managed Care.

Providers are strongly encouraged to check eligibility at each visit as eligibility and enrollment status may change at any time. If the Medicaid beneficiary is enrolled in a managed care plan, the first coverage message will indicate "Managed Care Coordinator.

When using a touch-tone telephone you will hear the "Description" of each covered service. If the message "All" appears, all services will be covered. Note: Medicaid will not reimburse a provider on a fee-for-service basis if MEVS indicates that the service is covered by the plan. Medicaid beneficiaries should contact their local department of social services to learn more about managed care. The Office of the Medicaid Inspector General OMIG reminds providers that they have an obligation to screen employees, prospective employees, and contractors, both individuals and entities, to determine if they have been excluded or terminated from participation in federal health care programs or New York Medicaid.

Click the "Resources" tab, then "Disqualified Individuals. Web searches should be performed for each individual upon hire and all employees, vendors, and referral sources should be rescreened on a monthly basis at a minimum. This will enable providers to capture exclusions and terminations that may have taken place since the previous search.

The OMIG Website allows providers to download a listing of all individuals to be matched against employees, vendors or referral sources, or providers can select the "short list" option, which offers a list of all changes that have occurred over the previous 30 days. Complete details, including definitions and regulatory citations, are also posted on the OMIG Website. New York Medicaid requires a valid diagnosis code on all new fiscal orders for supplies, durable medical equipment, prosthetics, and orthotics.

The diagnosis code must support the medical necessity for the item ordered. Failure to provide a diagnosis code on the fiscal order will result in delays for the beneficiary requiring necessary services. Please contact the Division of Provider Relations and Utilization Management at , option 1. Drugs, durable medical equipment DME , medical supplies, orthotics, prosthetics, and prescription footwear may not be separately billed to Medicaid when such items are already included in the rate of the recipient's residential care service.

This article describes the extent to which such items may or may not be included in the residential rates of OMRDD certified facilities. The intent is to summarize, but not alter, existing policy. These institutional care settings include funding for most types of supplies, drugs both prescription and non-prescription , DME, and prescription footwear. Items should be billed directly to the residence operator, not fee-for-service Medicaid, unless written instructions are received from the residence operator to do otherwise.

These institutions may authorize the direct billing of Medicaid for custom equipment required to transition individuals to non-institutional living arrangements, and for other purposes.

Item classes always excluded from the residential service rate bill fee-for-service Medicaid :. Items always included in the residential service rate bill residence operator, not fee-for-service Medicaid :. Note that food thickeners and enteral formulae are NOT in the list of supplies that must be covered directly by Intermediate Care Facilities for the Developmentally Disabled and supervised Community Residences and supervised Individualized Residential Alternatives.

Food thickeners and enteral formulae may be billed to fee-for-service Medicaid. There is no general prohibition against separate fee-for-service billing of diapers, underpads, OTC drugs, or gloves for the personal use of the resident for individuals living in supportive residences or family care homes.

Moreover, these residences rarely include funding for medical supplies, DME of any kind, drugs of any kind, orthotics, prosthetics, or prescription footwear.

All other items may be billed to fee-for-service Medicaid, unless you are otherwise instructed by the residence operator. Note: Where applicable, the rules outlined above apply to maintenance and repair services including separately itemized repair parts , as well as the original issue of equipment.

Please review the previous article directed to pharmacies, durable medical equipment DME dealers, and medical supply firms. The article clarifies the types of items typically included and excluded in the rates of various types of OMRDD residences. As a reminder, items included in a residential service rate must be purchased directly by the residence operator.

Items not included in a residential rate may be billed to the resident's Medicaid card. Providers are obligated to verify the status of specific items, in writing if requested, when questions arise as to whether the item is or is not included in the residential service rate.

Further, providers may be required to refund Medicaid the value of separately billed DME purchases that, on audit or review, are found to have been the financial responsibility of the residence. The Quick Punch Flow Chart provides callers with the appropriate prompt sequence needed to bypass call center messaging and proceed directly to the desired call center location.

The Desk Aid provides a brief overview of Pharmacy Prior Authorization programs, program updates, Websites, and contact information. The purpose of the National Provider Identifier NPI is to uniquely identify a health care provider in standard transactions, such as health care claims. The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.

Issue Select. Get Email Updates. To receive email updates about this page, enter your email address: Email Address. What's this? Links with this icon indicate that you are leaving the CDC website. A correct entry for license V would be V The EMEVS denial messages that will be returned upon implementation of the license verification project are:.

A list of valid license types was published in the March, Medicaid Update. Providers using alternate access methods will see this message as Denial Code Except for pharmacies, providers using alternate access methods will see this message as Denial Code REMINDER - When entering a license number ordered by an out-of-state provider, the two-character state alpha code must be entered after the license type but before the license number. An entry for a New Jersey physician with license number would be 11NJ NOTE: Effective with this project, telephone transactions where the ordering provider is out-of-state must include the converted alpha state code.

A correct entry via the telephone for the above number would be Questions regarding the project's edit criteria, correct entry format or denial messages should be directed to the EMEVS Provider Relations staff at Pregnancy may present a motivational opportunity for women to quit smoking.

Women can use this time in their lives to quit for themselves and for their babies. Physicians can be an especially influential factor when they suggest smoking cessation to patients. Ask your patients about smoking, including second-hand smoke. Advise your patients to quit smoking and assist your patients with a quit plan.

All pregnant women should be urged to quit smoking throughout pregnancy or advised not to start smoking after the baby is born. When a woman returns for the postpartum visit, a time of increased risk for relapse, physicians should reinforce the importance of not smoking for the mother's and baby's health.

Messages that can be used by health care providers to prompt smoking cessation before, during and after pregnancy include.

An additional support available to Medicaid recipients is a toll-free smoking help-line staffed by employees of the Roswell Park Cancer Institute.

The Quitline offers smokers a confidential and convenient way to access immediate help when they are ready to stop smoking or need support to remain smoke-free. Health care providers can also call the Quitline to obtain office materials that can be shared with patients. These publications, which can be given to patients, are available by calling Effective for dates of service on or after April 7, , Medicaid reimbursement is now available for ultrasound bone growth stimulators when medically necessary, prior approved, and ordered by a board certified or board eligible orthopedic surgeon for non-union fractures of the tibial shaft as evidenced by the following:.

Under no circumstances will ultrasound bone growth stimulation be approved for true synovial synarthrosis. In order to assess the benefit of this treatment modality on patient outcome and whether Medicaid resources are being spent wisely, follow-up on the status of patients who have used this system will be done.

For prior approval requests that are approved, the following information is required for submission at the time the non-union is healed or when other interventions are initiated surgery, etc. This information should be sent to Harvey Bernard, M. Please contact the Bureau of Program Guidance at if you have questions about this policy. Section 2.