Medicaid is dedicated to protecting your personal information against fraud and scams. You can help protect your license and personal bank accounts by being cautious in giving out your own personal information such as first name, last name, business name, email address, userid/password, financial information (credit card, bank account number, PIN), social security number, and driver's license...
The Medicaid Integrity Group (MIG) of CMS is required to review Medicaid provider actions, audit claims, and identify over payments. CMS has contracted with Health Integrity, LLC, to conduct audits of providers enrolled with the Nebraska Medical Assistance Program. Beginning in January of 2010, Health Integrity, LLC, will begin auditing providers. The review will include record requests, entrance...
Florida Medicaid The Florida Agency for Health Care Administration (Agency) announced today that Florida is the first state to launch a Medicaid claims-based electronic health record portal for providers. The Florida Medicaid Health Information Network powered by Availity is available through a common portal where similar records from other payers may also be accessed. This will allow health care...
New York State Medicaid Effective December 1, 2009, all orders for laboratory or radiology procedures must indicate the diagnosis by use of the appropriate ICD-9-CM code. Use of general ICD-9-CM codes such as those listed below or other non-specific codes does not satisfy this requirement. The following ICD-9 diagnosis codes are invalid as primary diagnosis codes for purposes of Medicaid...
CPT code 88299 - Unlisted Cytogenetic Study is currently reimbursable at a maximum rate of $10. Effective for dates of service on or after July 1, 2009, this procedure code will be subject to manual pricing and will require documentation for reimbursement.
Viral tropism tests are reimbursable through Medicaid fee-for-service using procedure code 87999 for Medicaid managed care enrollees. For Family Health Plus enrollees, these tests must be billed to the enrollee's health plan. Viral tropism testing identifies patients who are likely to respond to the new HIV entry inhibitor drug, Selzentry. Currently, one testing method (Trofile assay) is eligible...
While scheduled for March 1, 2009, implementation of APGs in Diagnostic and Treatment Centers (D...
The General Assembly recently approved a "50-percent budget" for the twelve-month period beginning July 1, 2009. That fiscal year 2010 budget underfunds a long list of vital services and programs, including the medical assistance programs administered by the Department. The General Assembly's "50 percent budget" cut over $1.4 billion from the Department's budget. Programs currently slated...
If the State of California does not enact the Fiscal Year 2008-2009 budget by June 30, 2008, the Department of Health Care Services (DHCS) will direct the fiscal intermediary (EDS) to continue to pay Medi-Cal practitioners and institutional providers through the MPIP fund until the loan is exhausted, which is anticipated to be by July 17, 2008. After that date, Medi-Cal institutional...
The Medicare, Medicaid, and SCHIP Extension Act of 2007 made several changes affecting payments to physicians. One such change provides for a 0.5 percent increase to the physician fee schedule conversion factor for January 1 through June 30, 2008, instead of the -10.1 percent that was scheduled to take place. As of July 1, 2008, the -10.1 percent update to the physician fee schedule will go into...
Florida Medicaid has published notice that effective for dates of service beginning on April 01, 2005, Medicaid is implementing a 10% reduction for all Medicaid independent laboratory fees. The reduction was mandated by the Florida Legislature because no contract will be in place by April 01, 2005. Conference Report HB 1835 - FY 2004-2005, line 210: "If by April 01, 2005, because of litigation or...
All chemistries ordered for ESRD patients must be billed individually with the following modifiers: CD - AMCC test that has been ordered by an ESRD facility that is part of the composite rate CE - AMCC test that has been ordered by an ESRD facility that is a composite rate test, but is beyond the normal frequency covered under the rate and is separately reimbursable based...
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level. Listed below are...