Feb 28, 2022 | Insurance & Reimbursement
From Dr. Milt Marasch, VPA Insurance Chair:
Here’s an FYI for folks. I just ran across a 2016 web article from the APA on problems with coding updates for the DSM-5. Apparently some of the DSM codes did not crosswalk well to the ICD-10 codes as printed in the DSM-5 manual.
Here’s the APA article:
https://www.apaservices.org/practice/reimbursement/icd-diagnostic/code-discrepancies#:~:text=10%20for%20Social%20Anxiety%20Disorder,diagnostic%20code%20for%20different%20presentations.
<https://www.apaservices.org/practice/reimbursement/icd-diagnostic/code-discrepancies#:~:text=10%20for%20Social%20Anxiety%20Disorder,diagnostic%20code%20for%20different%20presentations.>
And here’s the direct link to the ApA (psychiatry) PDF with changes/corrections:
https://psychiatryonline.org/pb/assets/raw/dsm/pdf/DSM-5%20Coding%20Update_Final.pdf
<https://psychiatryonline.org/pb/assets/raw/dsm/pdf/DSM-5%20Coding%20Update_Final.pdf>
Feb 28, 2022 | Insurance & Reimbursement
You may have received a 1099 for the Provider Relief Payment you received in 2020, and you may be asking whether that payment is taxable. Normally when you receive a Form 1099 for income, that income is taxable, but because VPA is not able to provide legal or tax advice, we recommend you speak to the IRS helpline, your accountant or tax expert about the issue.
You can see some additional information on here.
Feb 28, 2022 | Insurance & Reimbursement
Cotiviti is the record retrieval contractor for VT Medicaid and has begun outreaching selected providers to request the submission of medical records in support of VT Medicaid’s Medical Record Review (MRR). Cotiviti will call each provider to confirm they have reached the correct office before faxing a record request letter and a member request form or a member list with the names of the Medicaid members for whom they are requesting records. The cover letter will be on VT Medicaid letterhead. Please pay close attention to the HEDIS Measure Requirements and Date of Service fields and only submit the type of record requested within the stated timeframe. For more info visit https://dvha.vermont.gov/providers/audits/hedis-hybrid-measure-medical-record-review-mrr.
Feb 28, 2022 | Insurance & Reimbursement
DVHA will be providing an overview on the Vermont Medicaid Medical Record Review (MRR) request letters; the data requested will be used to compare to HEDIS performance measures each year to gauge our members well-being. This training will review the medical record review request, including the type of documentation being requested and the timeframes around the request and will provide information about who should expect to receive these request letters.
If you would like to join this webinar hosted on April 21, 2021, at 11am, please send an email to vtproviderreps@dxc.com, including your name, phone number and email address, by April 12, 2021. If you would like more information on the details of this webinar, please contact your Provider Relations Representative directly.
Feb 28, 2022 | Insurance & Reimbursement
From VPA Insurance Committee:
The short version of the information provided below, is that the extension of the public health emergency (PHE) is expected on the federal level, and I would imagine this would be mirrored on the state level as well. Medicare rules about originating sites have been or are being relaxed post PHE. Vermont Medicaid, BCBSVT, and MVP (at least Vermont’s MVP plans - not sure about the NY ones) already are required to reimburse for telehealth. The biggest change post-PHE is likely to be that the waivers for audio-only telephone and non-HIPAA compliant platforms like Facetime go away. The more detailed list of information and sources follows:
- APA Services telehealth guidance by state: Note that the public health emergency extension information is a bit out of date for Vermont on this one, but gives a helpful overview of state info otherwise. Scroll down for Vermont. See here: https://www.apaservices.org/practice/clinic/covid-19-telehealth-state-summary
- State of Vermont declaration of public health emergency: Set to expire April 15th as of this writing. No clear indication of what further extension the governor may do, but looks like it typically gets extended a month at a time. I suspect would probably continue extending as the federal government is expected to do. Check here for current status information: https://governor.vermont.gov/covid19response
- Federal government or CMS declaration of public health emergency: Was most recently renewed on January 7, 2021, effective January 21, 2021, with a 90- day expiration. Per personal communication with APA Services’ Diane Pedulla, “The PHE is currently in place through April 20th, but the administration has indicated it will renew the PHE at that time, possibly for the rest of the calendar year.” Current emergencies web page: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
- Traditional Medicare (NGS is the carrier in Vermont): Again, per communication with Diane Pedulla, “The Consolidated Appropriations Act of 2021 removes the geographic location and originating site requirements for mental health services furnished via telehealth. These changes become effective once the public health emergency (PHE) ends.”
- Vermont Medicaid telehealth information: Covered even after PHE, but I would expect audio-only telephone or non HIPAA-compliant audio-video platforms to lose their waiver status. See both your Medicaid provider handbook and here: https://dvha.vermont.gov/providers/telehealth
- Vermont insurances - BCBSVT & MVP: VPA’s executive director Lynda Marshall has kindly provided me with the following links to statutes applying to Vermont insurances being required to reimburse for telehealth ( https://legislature.vermont.gov/statutes/section/08/107/04100k ) and provider requirements, e.g., informing the patient ( https://legislature.vermont.gov/statutes/section/18/219/09361)
- Out of state insurances: Please refer to those provider manuals or representatives for information.
