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091510 N EW S BLAST**LA MEDICAID’S IMPLEMENTATION OF MCKESSON CLAIMCHECKand FEE SCHEDULE CHANGES **Since LA Medicaid uses the McKesson ClaimCheck claims editing system for processing claims, (thisimplementation date was effective with processing date of 05/17/10, not Date of Service (DOS))ClaimCheck now takes precedence over information printed on the LA Medicaid fee schedule, i.e., GlobalSurgery Periods (GSP) indicators and all previously published information.Several areas have been impacted by this implementation, i.e., Global Surgical Period (GSP), New Patient Visits,Use of Modifiers, Bundling Edits, etc.Please review prior Newsletter and News Blast articles published regarding this topic on MEDTRON’sWEBSITE, www.medtronsoftware.com, Newsletters & News Blasts page.Valuable links and information regarding ClaimCheck are available via LA Medicaid's eck/ClaimCheck.htm**UPDATE** Regarding modifiers:Audits regarding proper use of modifier 24, 25, 57 and 59 are starting to surface. Please know how toproperly apply and document for use of these and any other modifiers. MEDTRON/MEDDATA maintains aModifier Grid to assist users in identifying proper modifier usage. The Modifier Grid is available DIFIER GRID/Modifier Grid.xlsAlso NOTE: MEDDATA/MEDTRON has just been able to validate that Medicaid claims no longer requiresmodifier 51 on secondary or multiple procedures. Medicaid still has not published their AcceptedModifier list on the website; therefore, until further notice, we will continue to presume thatHelp TEXT,Search IndextoMedicaid will recognize all Medicare modifiers – seeModifiers: Medicare.The only modifier list that Medicaid has published so far, but did indicate that this is not the final list, isavailable on LA Medicaid's website, mCheck.htmClick on CLAIMCHECK WEBINAR PRESENTATION APRIL 27-29 /Provider Training Print.pdf)Review slides 13 & 17NOTE: McKesson ClaimCheck Bundling Edits do not agree completely with Medicare Bundling Edits, i.e., CCI/NCC.Recent Medicaid cuts have been radical and retroactive, see attached for details and emailmedicaidprofessionalservices@la.gov to find out just how much your projected ‘take back’ adjustment is!REMINDER: LA Medicaid’s new fee schedule cuts are based on Medicaid’s new allowables using a percent (%)of Medicare, if Medicare fee schedule goes down Medicaid does too!MEDDATA/MEDTRON will continue to provide updates as available from LA Medicaid.
SUMMARY OF INCREMENTAL CHANGES TO REIMBURSEMENT FOR LA MEDICAID PROFESSIONAL SERVICESEffective January 1, 2008In general, all services were reimbursed at 90-120% of 2008 LA Medicare Region 99 for all recipients.Effective February 26, 2009Laboratory/radiology services were reduced by 3.5% of the Medicaid fee in effect on Feb 25, 2009 for all recipients.Effective August 4, 2009In general, services rendered to adults (16 years of age and older) changed to 80% of 2009 LA Medicare Region 99.The following services remained at the Medicaid fees in effect as of Jan 1, 2008: All Services to Recipients 0 through 15 Years of Age (with exception of lab/radiology services as denoted below) Preventive Medicine Evaluation & Management (E/M) and Immunizations Family Planning Prenatal Evaluation & Management (E/M) and OB Delivery Select Orthopedic Reparative Codes Physician Administered DrugsLab/radiology services were reduced by 4.7% of LA Medicaid fee in effect on Aug 3, 2009 for all recipients.Effective January 22, 2010In general, services rendered to adults (16 years of age and older) were reduced to 75% of 2009 LA Medicare Region99 (including select orthopedic reparative codes) with the exception of the following services. These services werereduced to 80% of 2009 LA Medicare Region 99: OB Delivery, Prenatal E/M, and & Preventive Medicine E/M.Services rendered to recipients 0 through 15 years of age changed to 90% of 2009 LA Medicare Region 99 (includingOB Delivery, Prenatal E/M, and Preventive Medicine E/M).The reimbursement for immunizations remains at the fees in effect as of Jan 1, 2008 for all recipients.Physician Administered Drugs changed to 90% 2009 LA Medicare ASP for all recipients.Lab/radiology services were reduced by 4.42% of LA Medicaid fee in effect Jan 21, 2010 for all recipients.Effective August 1, 2010Enhanced fee for service rates reimbursed to CommunityCARE providers are being discontinued in order to align thereimbursements with the established fees for primary care services rendered by providers in the ProfessionalServices Program. Note: The CommunityCARE monthly management fee remains in place.Lab/radiology services were reduced by 4.6% of LA Medicaid fee in effect July 31, 2010 for recipients of all ages.8/2010
Bobby JindalAnthony KeckGOVERNORSECRETARYState of LouisianaDepartment of Health and HospitalsBureau of Health Services FinancingMEMORANDUMTO:Louisiana Medicaid PhysiciansFROM:Don GregoryDirectorRE:Professional Services ReimbursementDATE:August 24, 2010We are all facing one of the most difficult times in several decades relative to the stateeconomy and available funding for state funded programs such as Medicaid. I amwriting to you today regarding the Medicaid reimbursement rate reductions put in placeover the last year and the claim adjustments resulting from a delay in implementation ofthese reductions. You have likely noticed both the adjustments and the recentpostponement of these adjustments in your weekly remittance. This memo will explainour methodology up to this point, and provide you with some options as we moveforward.The Louisiana Medicaid Program is tasked with developing payment methodologieswithin the limits of available state and federal program funding. We are mandated to doso without significantly impacting access to medical care for the Medicaid population.We worked on targeted changes to our payment methodology in order to protect access tocare. Refer to the summary accompanying this memo for a detailed outline of theincremental changes made to Medicaid reimbursement for professional services throughthe budget shortfalls. The targeted changes made to protect services to recipients zerothrough fifteen (0-15) years of age, in particular, required complex system changesresulting in delayed implementation of the August 4, 2009 and January 22, 2010 ratereductions.We recognize that Medicaid reimbursement rate reductions and the subsequent claimadjustments have caused accounting and financial challenges for Medicaid providers.When adjustments were initiated for the cuts effective back to August 4, 2009, thedecision was made by the Bureau to spread it over an extended period in order to have alimited impact on cash flow to our provider community. Based upon discussions withBienville Building 628 North 4th Street P.O. Box 91030 Baton Rouge, Louisiana 70821-9030Phone #: 225/342-3891 or #225/342-4072 Fax #: 225/342-9508 WWW.DHH.LA.GOV“An Equal Opportunity Employer”
August 24, 2010Page 2providers, the weekly adjustments were postponed effective July 27, 2010 in order for theDepartment to explore options to further reduce the impact of these adjustments.The Bureau must realize the savings associated with these adjustments before June 30,2011. Because we would like to accomplish this goal with the least amount of impact toproviders, we have made the following changes to our methodology:The adjustments will occur in order by billing provider number over two midweekRemittance Advices (RAs) independent of the normal weekly RA.Each provider will see their remaining adjustments on only one of the midweekRAs, either September 22, 2010 or October 6, 2010.The adjustment balance will not be deducted from either of the midweek RAs.Instead, the balance will be divided and applied in equal amounts to the normalweekly RAs immediately following the midweek adjustment RA & continuethrough June 7, 2011. Any remaining balance after the June 7, 2011 RA must bepaid in full by June 30, 2011.Please note that the adjustment balance will equal the total adjustment amountless any adjustments for claims that encounter edits due to system changes sincethe claim initially paid. It is anticipated that there will be a minimal number ofsuch claims so these will be resolved in each providers’ future normal weeklyRAs.Providers may contact Bureau of Health Services Financing to inquire about analternative payment plan, request an estimated total dollar amount of the adjustmentbalance, or submit any questions. These inquiries may be submitted via e-mail tomedicaidprofessionalservices@la.gov, or written correspondence to:Bureau of Health Services FinancingProfessional Services ProgramP.O. Box 91030Baton Rouge, LA 70821We would also like to take this opportunity to remind providers of the availability of theelectronic remittance advice (835 transaction). This format may already be available toyou through your billing agent and could significantly improve your ability to reconcileany claims adjustments with your accounting records. We have also improved the paperremittance in order to better meet your accounting and record keeping needs. EffectiveAugust 24, 2010, a change has been made to the LA Medicaid paper RA to display a“NET” amount for Adjustment/Previously Paid claims. This is intended to help addressprovider’s concerns with reconciling adjustments in their RAs.
August 24, 2010Page 3Despite these reductions, the fiscal year which just began on July 1, 2010 poses its ownset of budgetary challenges. We are appealing to the provider community for ideas inmaking the Medicaid Program more efficient. Please send any programmatic or policysuggestions to the above-referenced e-mail or post office address. Documented researchor published studies that show the efficacy of any recommended policy changes, withregard to improving health outcomes and/or cost savings, would be especially useful inpreparing for upcoming rate adjustments.The Department of Health and Hospitals greatly appreciates the service that you provideto the citizens of Louisiana and thanks you for your attention to this matter.DG/KV/mjEnclosure
NOTE: McKesson ClaimCheck Bundling Edits do not agree completely with Medicare Bundling Edits, i.e., CCI/NCC. . Laboratory/radiology service were reduced by 3.5% of the Medicaid fee in effect on Feb 25, 2009 for all recipients. Effective August 4, 2009 In general, service rendered to adult (16 year of age and older) changed to 80% of 2009 LA .
