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.
Feb 28, 2022 | Insurance & Reimbursement
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 & Reimbursement
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)
Feb 28, 2022 | Insurance & Reimbursement
There have been mixed reports about place of service codes from insurance companies. Our Insurance Chair, Milton Marasch, has received word from Blue Cross Blue Shield Vermont in regards to how new CMS policies will affect their place of service does.
A representative from the company has indicated there will be no change in their place of service code procedures for telemedicine: The American Medical Association released a new place of service code for telemedicine – place of service 10, which is effective January 1, 2022. Our Payment Policy for Telemedicine CPP_03 will not be updated for January 1, 2022, however, until further notice, either place of service for telemedicine (02 or 10) will be accepted and processed by our system.
The CMS has a listing of the new AMA place of service (POS) codes and their descriptions - including the new POS=10 code, that should also be noted. The question was raised as to whether the POS=02 code would be used instead for the rare circumstances where the patient is a resident in a nursing facility instead of in a traditional home. The representative reported that they will accept either the place of service 10 or 02 for patients in a nursing facility that are receiving telemedicine services.
REFERENCES:
CMS link on the place of service (POS) codes: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
BCBSVT documentation (bottom of page 2): https://www.bluecrossvt.org/documents/january-2022-adaptive-maintenance-provider-news
New BCBSVT website link (pointing directly to providers’ section): https://www.bluecrossvt.org/providers
Feb 28, 2022 | Insurance & Reimbursement
We encourage members to review insurance coding announcements from your various insurances on any coding changes for audio-only telehealth services. For instance, MVP has just announced Modifier V3 and Place of Service (POS) code 99 (“other”) for plain old telephone therapy, effective January 1st. We recommend taking a look directly at your insurance announcements on this topic for definitive information, or the MVP payment manual here (PDF page 21).
