Mar 23, 2022 | Insurance & Reimbursement
The Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1, 2021, through June 30, 2022. Providers with a sampled claim will receive a medical record request letter from NCI Information Systems, Inc., and are required to submit all requested claim medical records and documentation.
The first request letters are expected by early April. Providers have 30 days from date of receipt of notice to submit required claims medical records and adjoining documentation to NCI Information Systems, Inc. If additional information is needed, providers have 14 days from the date of receipt of notice to send in the information. DVHA will enforce a 10% withholding from all providers that do not submit the required medical record and adjoining documents within 30 days or the additional documentation within 14 days.
Beginning in March, providers with a sampled claim may be contacted by a state representative to confirm the correct contact information prior to the request letters going out.
NEW: CMS will be hosting a few webinar sessions for providers focusing on the below topics:
• The PERM process and provider responsibilities during a PERM review
• Recent trends, frequent mistakes and, best practices
• The Electronic Submission of Medical Documentation, esMD program
These sessions will be held on:
• Tuesday 4/12 1pm-2pm
• Wednesday 4/13 3pm-4pm
• Thursday 4/14 3pm-4pm
Please see https://dvha.vermont.gov/providers/audits/payment-error-rate-measurement for a link to register for the webinar. Registration closes April 10th.
Mar 16, 2022 | News
If you’re looking for the new Medicaid rate schedule, you can find it here: http://www.vtmedicaid.com/#/feeSchedule. Click on the green “Open Menu” button in the upper left part of the page, and you can search by CPT code in the blank box at the top of the table.
Mar 9, 2022 | Advocacy
From Dr. Rick Barnett:
Hello Div55ers and VPA Members,
Here is a brief update on Vermont’s RxP effort, with a longer description coming next week (after I meet with the lobbyist).
I spoke with the Office of Professional Regulation today who spear-headed a “Sunrise Review” Process. The report that was to be submitted to the House Government Operations Committee in January has not yet been completed. The word is that it will be a favorable recommendation with several caveats, and it will be kicked to the next Biennium (this will be Vermont’s 4th Biennium, it is on a 2 year legislative cycle) with an RxP bill.
So, the work will continue into next year. In the meantime, more discussion and addendums have been written that will focus on the regulatory oversight process (for example, proposing a subcommittee of prescribers be created to serve as needed on Board of Psychological Examiners), beefed up clinical training requirements (a hybrid of Illinois and Idaho and not modeling NM or LA), and getting realistic expectations on the long-term uptake of this new workforce (citing those currently enrolled in the various RxP training programs across the country). This likely means a new bill (but not necessarily).
This is not bad news at all! We are in this for the long haul. We stand on the shoulders of giants who have gone before us with vision, persistence, and conviction. Much gratitude to all of you who guide and inspire us along the way!
Feb 28, 2022 | Insurance & Reimbursement
Switching SSN to FEIN for Enrollment Type “Individual” Vermont Medicaid does not require that providers switch their enrollment from SSN to EIN, but many providers are choosing to make this change. If you are an Individual Provider choosing to switch your enrollment from SSN to EIN, please navigate to http://www.vtmedicaid.com/#/home, click on “Provider Enrollment” at the top of the screen and choose the third option from the top; “Instructions”. Then, open the “Green Mountain Care Instructions for Enrollment & Revalidation”. Next, scroll to Section 12.3 Switching SSN to FEIN for Enrollment Type “Individual”. This section contains the specific process that must be followed in order to make this update. If you have questions about this process, please outreach to the Provider Services Help Desk at 800-925-1706.
2022 HEDIS Performance Measure Production Includes a Medical Record Review (MRR) Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of health care performance measures in the United States. VT Medicaid produces these measures to measure health plan processes and member health outcomes. To produce some of the HEDIS measures, DVHA must request members’ medical records from providers and then trained clinicians review and abstract data from the member’s record that does not show up in claims data. Cotiviti is the record retrieval contractor for VT Medicaid and will begin outreaching selected providers in March and requesting the submission of medical records to support VT Medicaid’s 2022 Medical Record Review (MRR). For more info, please visit: https://dvha.vermont.gov/providers/audits/hedis-hybrid-measure-medical-record-review-mrr.
Feb 28, 2022 | Insurance & Reimbursement
The Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1, 2021, through June 30, 2022. Providers with a sampled claim will receive a medical record request letter from NCI Information Systems, Inc., and are required to submit all requested claim medical records and documentation. The first request letters are expected in late March or early April. Providers have 30 days from date of receipt of notice to submit required claims medical records and adjoining documentation to NCI Information Systems, Inc. If additional information is needed, providers have 14 days from the date of receipt of notice to send in the information. DVHA will enforce a 10% withholding from all providers that do not submit the required medical record and adjoining documents within 30 days or the additional documentation within 14 days.In early March, providers with a sampled claim may be contacted by a state representative to confirm the correct contact information prior to the request letters going out. Please see https://dvha.vermont.gov/providers/audits/payment-error-rate-measurement for more information.
