Mar 23, 2022 | Insurance
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.
Feb 28, 2022 | Insurance
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
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.
Feb 28, 2022 | Insurance
To access Full Banners, please visit: http://vtmedicaid.com/#/bannerMain
January 28, 2022
Change to VT Medicaid Admission Notification Form for Inpatient and Detoxification Services
The Department of Vermont Health Access (DVHA) has updated the VT Medicaid Admission Notification Form for Inpatient Psychiatric & Detoxification Services which is required to be faxed within 24 hours or next business day of an urgent or emergent hospital admission. Two questions on Medicare or other insurance coverage have been added. Please begin using this form 01/28/2022. You can access the write in version and the type in version on the DVHA website at: https://dvha.vermont.gov/formsmanuals/forms/clinical-prior-authorization-forms.
Guidance on the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule
The Centers for Medicare & Medicaid Services (CMS) released guidance on the Omnibus COVID-19 Care Staff Vaccination Interim Final Rule (http://dvha.vermont.gov/news/guidance-omnibuscovid-19-health-care-staff-vaccination-interim-final-rule) that was published on November 5, 2021. The emergency regulation is intended to help safeguard health care workers and the people they serve from COVID-19 and its variants for all individuals seeking care by imposing requirements regarding vaccinations for eligible staff at many health care facilities participating in the Medicare and Medicaid programs. Health care workers in CMS-certified facilities must be vaccinated. The Interim Final Rule and this CMS guidance apply to nursing homes, home health agencies, hospices, hospitals, ambulatory surgical centers, federally qualified health centers, end stage renal disease facilities, and rural health clinics. It does not apply to Designated Agencies. The guidance provides important information on implementation as well as guidelines to assess and maintain compliance with the COVID-19 vaccination requirements.
More information, including Frequently Asked Questions, may be found under the “Clinical and Technical Guidance for All Health Care Providers” at the following link: https://www.cms.gov/AboutCMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.
Please refer to the COVID-19 Page https://dvha.vermont.gov/covid-19 often for updated information.
Feb 28, 2022 | Insurance
As of January 16, 2022, the US declaration of a Public Health Emergency has been extended until April 16, 2022. This means that all accommodations put in place–such as telehealth and waivers–will remain for another 90 days.
Source:
US extends “public health emergency” due to the COVID-19 pandemic. (cmadocs.org)
