|
||||||||
|
||||||||
| 6/1/08 – Proposed New Rates 7/1/08 Please see the attached documents for the proposed new rates effective 7/1/08. Res Hab rates effective 07-01-08 with reductions 05-19-08 Table Rate Reductions Other Service Promulgation 5-19-08 05/27/08 EDS will be taking over as the new Medicaid Fiscal Agent on June 24, 2008 Because of the transition, there will be some important dates to take note of:
1/1/08 Res Hab Increase Procedures Attached link outlines procedures for the res hab rate increase effective 1/1/08. Call your local APD if you have specific questions.
12/29/07 – APD Long Range Goals
12/28/07 – Problem with Res Hab Monthly Proc Codes 1/2/08 Update: APD has notified us that the issue has been resolved and AHCA agreed to run another update of the gatekeeper on Wednesday evening. This means that any denied monthly res hab claims can be resubmitted and new monthly res hab claims can be submitted as early as Thursday, January 3. Because of this issue, ACS has agreed to accept claims through Friday, January 4 for processing. If claims are billed this week, expected pay date would be Thursday, January 10. Please note that if you billed for res hab this week using the new monthly res hab codes, your claims will not pay out next week. Apparently a system glitch between ABC and the update of the gatekeeper was discovered and being investigated. At this time, no information as to when the issue will be resolved has been given. As always, we will follow the progress closely and rebill your claims as soon as possible. Please do not inundate the State with your calls as we are in direct contact with them and will relay information as soon as we receive it. The more calls they have to return takes away from the time they can spend on dealing with this issue. 10/29/07 Implementation Procs for Eliminated/Changed Svcs Click on link below to review the implementation procedures for the eliminated services effective 12/1 as well as changed services effective 1/1/07.
Planning for the Elimination of Services Revised Implementation Procedures for Res Hab Rates Effective 12/1/07 The new monthly res hab rate is now based on 24 DAYS PER MONTH SO PROVIDERS CANNOT SUBMIT THEIR MONTHLY RES HAB BILLING UNTIL THERE ARE AT LEAST 24 DOCUMENTED DAYS OF ATTENDANCE. Previously this was set at 20 days per month. Keep in mind providers still have to adhere to the Medicaid weekly claim deadline (Wednesday) so if you want to bill on the 25th of the month, if that date falls on a Thursday or Friday, it is likely that the claims will not pay out the following week. In addition, clients of Expert Billing also have to adhere to our guidelines that invoices are submitted to us by Tuesday at Noon to ensure we have enough time to process to meet Medicaid’s weekly deadline. Implementation procedures for res hab- rates REV 10-15-07 Expanded Versions of the Res Hab Rate Table RH Provider Information sheet REV 10-20-07 10/12/07 Postponement of Res Hab Changes Until 12/1/07 APD has issued a statement that they will be postponing the implementation of the new res hab rates until December 1, 2007. Please read email directly from Jane Johnson below: ************************************* We are working on a revised rate restructuring proposal in response to the input we received from providers as well as a recognition that our original proposal appeared to have a disproportionate impact on individuals with the most intense needs, which was not an intended outcome. We hope our revised proposal mitigates the impact on those who are most vulnerable and would have the most difficulty finding another place to live. 10/1/07 Res Hab Monthly Billing It has been confirmed by Tallahassee, that when billing the new monthly res hab rate, once providers have documented 20 days of attendance, billing can be submitted for the month. Please keep in mind that this means you will still only be billing and getting paid ONE TIME per month. Please make sure to amend your monthly invoices to show the correct MONTHLY rate. You should still use a daily attendance log as your invoice but rather than having a daily rate, you will be billing 1 UNIT at the MONTHLY rate. You cannot submit billing until you have received your new authorization. The new monthly rate does not affect foster care homes that have the live-in res hab rate approved. Foster care providers should contact their local APD office if further clarification is needed. Res Hab Changes Effective 10/1/07 Please read the policy on the new res hab rates to see how your rates will be affected. Please be aware that these changes will most likely cause billing delays. If you have questions, please contact your local APD office or your coordinator.
9/14/07 Governor’s Budget Reduction Recommendations Click on here to read the Governor’s budget recommendations as of 9/13/07 9/4/07 APD announces decision to have support coordination remain with independent providers. Recently APD announced their intent to turn support coordination over to state employees as a way to help reduce their budget. Thanks to everyone’s commitment to save support coordination for the sake of the clients, it was officially announced last week that APD has decided not to make this recommendation to the legislature and for support coordination to remain the responsibility of independent support coordinators. Keep up to date by periodically reviewing the APD website. 7/16/07 – Problem w/Payment for 7/19/07 It has come to our attention that there is a problem with several claims from last week. It appears Medicaid did in fact pay the claims, but they paid them out at ZERO dollars. This problem was widespread but sporadic as some provider’s claims paid out just fine. It affected all providers whether they bill on their own or use a billing agent. At this point, we are waiting to get more information on the issue and are not sure if the problem will be resolved in order to make the payment for Thursday. We will continue to email updates as we receive them. If you were one of the providers that were affected by this, past experience tells me that you should make alternate funding plans for this week. If in fact, the issue is resolved and claims are reprocessed for payment on Thursday, it will be a nice surprise for you, but just in case they don’t, you’ll have already made plans that the monies won’t be received this week. Update 7/17/07 It has been confirmed that Medicaid will correct the problem by automatically processing adjustments. However, the adjustments will not process until next week. Unfortunately this means that the claims that were expected to pay this week will NOT be paid until next week. Sorry for the bad news, but this is one of those situations that could not be foreseen. 7/13/07 WaiverProvider.com WaiverProvider.com is a new website that links support coordinators and providers together as well as provides loads of resources. Providers can even advertise their business for a small fee. Visit WaiverProvider.com for more information. 7/9/07 ACS No Longer Claim Payor Effective March 2008 ACS has lost the contract with Florida Medicaid to process all Medicaid claims. Effective March 2008, EDS will begin processing claims for Medicaid. Unfortunately, Winasap is a product of ACS so it will no longer be usable. Clients of Expert Billing will not be affected. Providers that are billing on their own, contact your local Medicaid office for details on upcoming trainings. 5/7/07 – FAQs to Recently Approved Changes on Waivers FAQs have been posted on the APD website regarding the recently approved changes to the Waivers: visit http://www.apd.myflorida.com/about/medicaid-waiver.htm 5/1/07 – Capital Update Regarding MW Program View the Capital Update newsletter click here to see what changes will be implemented effective July 1, 2007. If you have questions, please contact your local APD office or your support coordinator. 4/24/07 Service Authorization Effective Date Changes It has been confirmed that the transition to have all service authorizations start July 1 to coincide with the fiscal budget year has begun. The process should run fairly smooth, but as always, you will want to communicate with your SC to ensure there are no shortages in funding. The following changes are being implemented: Service authorizations with effective dates in May or June will now end June 30, 2007. New authorizations will be issued effective July 1 through June 30, 2008. If you have already been issued authorizations for plans starting in May or June, you will not be issued interim authorizations in 2007. When your current authorization is expired, you will be issued an interim authorization that will have enough funds to cover through June 30, 2008 and then a new 12 month authorization will be issued effective July 1, 2008. Service authorizations with effective dates in July are not affected. Services authorizations with effective dates in August or after will only have enough funding to go through June 30, 2008. Please remember to send Expert Billing copies of updated authorizations to avoid billing delays. 4/17/07 All Children Under 18 Moving to FSL Waiver One of the significant changes that may be implemented in the near future is that all children under 18 will be moved to the FSL Waiver. If you are a provider that serves children under 18 and do not have an FSL provider number, contact your local APD to request you be added to this Waiver. If this change is implemented and you do not have an FSL provider number, you will be unable to continue serving these clients. 3/27/07 ACS Relaying Incorrect Payment Information This week ACS and Medicaid are having system problems and the system is not giving out correct payment information. If you have called Provider Check Inquiry to verify your payment for the week, it will not be correct. Actual payments due on Thursday are not expected to be affected. At this time, they are unable to say when the system will be corrected. If you are a client of Expert Billing, you can call us to verify payment. For all other providers, you can call Provider Claim Inquiry to verify your claims have been paid. 2/14/07 Supported Living Billing Limitations On 2/14/07 APD and Medicaid updated the system to limit the number of quarter hours per day or per claim line to 40. This means that billing can no longer be lumped and must be submitted on a day-to-day basis not to exceed 40 quarters per day. Since this change was not communicated prior to its implementation, it is likely that most claims were cutback to only pay the 40 quarter hours. If you were affected by this and are a client of Expert Billing, please contact our office so that we can resubmit the claim correctly. If you are not client of Expert Billing, you can contact Claim Inquiry to determine your course of action. At this time, we are unsure if this daily limit will be permanent. Until we receive information that it has been changed, we will be submitting all SIL claims on a day-to-day basis. Please remember that this means providers cannot work more than 40 quarters on any given day. As a reminder, it is a good idea to review the billing code matrix on a regular basis. You can access the current billing code matrix here (Unfortunately, this change to the SIL limits has not been posted yet.) 2/5/07 – EDI File Transmission Errors The week of 1/30/07-2/2/07 EDI (the company that accepts the transmitted claim file and forwards them to Medicaid for processing) experienced problems with their servers. Even though Expert Billing received confirmation that the file transmissions were accepted, the files were not transferred over to Medicaid for final processing. On Wednesday, when they realized there was a problem, they manually forced the claims that were submitted by Wednesday (the weekly deadline); however, the claims that were transmitted on Thursday and Friday are still sitting in their system. Expert Billing is working closely with EDI to track the affected files to be sure they are sent to Medicaid for processing. If there is no resolution by Tuesday, February 6, Expert Billing will resubmit the claims. If Expert Billing resubmits the claims and EDI sends the original file to Medicaid, providers will see duplicate claims on the remittance voucher. The second claim will simply deny for a 101 – duplicate transaction. 1/23/07 - National Provider Identifier (NPI) Number HIPAA regulations required the adoption and use of a standard unique identifier (National Provider Identifer or NPI) for health care providers. The guideline requires that all claims include the NPI by May 23, 2007. There has been conflicting information regarding whether Medwaiver providers required an NPI number or not. Please view the links to read the information on the issue. If you have questions, please contact the NPI Help Desk at 866-496-6493. For clients of Expert Billing, we are recommending providers go ahead and obtain an NPI number. This way, if it is ever determined in the future that you are required to have one, you will already have it. Please review the APD website for further clarification. Document Links: NPI Letter , Fact Sheet and Frequently Asked Questions 01/17/07 – November Supplemental Payment Paid Twice On 1/10/07, Medicaid accidentally paid the supplemental payment for the November rate increase a 2nd time. Originally, the November increase was paid on 12/13/06. The error was discovered last week so this week another adjustment has been processed to recoup the incorrectly paid increase. The amount of your increase paid on 12/13 will be deducted from your net pay on 1/17/07. If you were not supposed to receive a payment on 1/17/07, the monies will be deducted from your next pay. 1/1/07 – PROVIDER RATE INCREASE Effective January 1, 2007, all providers should be billing with the increased rates for claims with dates of service of January 1 and after. If you have not received an updated service authorization from your SC, contact them immediately to avoid billing delays. Please remember that claims for dates of service prior to January 1 should still be processed using the current rate. Supplemental payments will continue to be processed through December 2007 for claims with dates of service between July 1 and December 31, 2006. 9/26/06 SUPPLEMENTAL PAYMENT EXPLANATION There has been a lot confusion regarding the supplemental payments (raises). Here is the scoop… One time per month ACS will process adjustments for claims PAID the previous month that qualify for the increase (only claims with dates of service of 7/1/06 or later). All adjustments will be processed before the end of the month. As an example, weekly billers received a supplemental payment on the first run on 8/9/06 because you were PAID for claims with dates of service of 7/1/06 or later IN THE MONTH OF JULY. Monthly billers billed for JULY claims at the end of the month and claims were not actually PAID until August so the supplemental payment for these claims was not paid until September. In order to keep track of the adjustments, providers will have to keep all their remittance vouchers for each month and compare it to the adjustments run the following month. I believe that in the end, everything will come out correct, it’s just a matter of understanding the system. If there are additional questions, providers can contact their local APD office. Clients of Expert Billing can contact our office for further explanation. 8/24/06 – RES HAB & ADT PROVIDER PAYMENTS FOR 8/24/06 Update to 8/21/06 posting regarding
payments expected on 8/24/06 (original posting below): However, please be aware that because the settlement was not supposed to be issued in this manner, the direct deposits for the affected providers have been cancelled for this week. These providers will receive a paper check for the paid claims for this week. After the attorneys have reviewed the settlement checks for each provider, they will be mailed out with a letter of explanation to each provider. At this time, there is no estimated timeframe for these checks to be mailed to providers. 8/21/06 - PAYMENTS EXPECTED ON 8/23/06 As you are probably all aware by now, in order to pay the rate increase that was effective 7/1, Medicaid was going to be issuing supplemental payments via adjustments. This process was supposed to be done one time per month. There was an error this past weekend and supplemental payments were issued to some providers. In most cases, the supplemental payments were significantly higher than what they should have been. This resulted in huge overpayments to many providers. The APD central program office is working on the problem with programmers now to determine how this will be corrected. PLEASE BE AWARE THAT ALL OVERPAYMENTS WILL BE RECOUPED. The money has been paid out so the money is in the provider’s account. However, once the programmers determine how the error will be corrected, the monies will be deducted from future pay. THIS MEANS THAT PROVIDERS COULD END UP RECEIVING NO PAYMENTS UNTIL THE RECOUPMENT IS COMPLETED. PLEASE PLAN ACCORDINGLY FOR THIS. Additional information will be posted as it becomes available. 8/1/06 – Provider Rate Increase As you are all aware, all providers are receiving a rate increase effective 7/1/06. Until now, how the implementation of the increase would be applied was under discussion. It has been decided that all providers will continue to bill at the current rate from July 1-December 31, 2006. During this time, providers will receive a supplemental payment for all claims billed and paid that qualify for the increase via an automatic adjustment. What this means is that each month Medicaid will review all paid claims from the previous month and automatically process an adjustment for the qualified claims and the supplemental payment will be issued. You will see the adjustments on your remittance vouchers. Supplemental payments will continue to be issued through December 31, 2007 to ensure that all claims that qualify for the increase are adjusted. During the next few months support coordinators along with APD staff will be responsible for updating the ABC system and issuing updated service authorizations. All providers should receive their updated authorizations by the end of December so that billing with the new rates can begin on January 1, 2007. Most likely, your support coordinators will be contacting you to get an estimate of the hours/days planned to be used through the end of the year to help ensure that the new authorization effective 1/1/07 is accurate. Providers should receive 2 authorizations: 1 ending 12/31/06 with the old rate and 1 beginning 1/1/07 with the new rate. 7/31/06 – No Payment for the Week of 8/4/06 EDI (the clearinghouse that accepts Florida Medicaid claims) announced that there have been several sporadic glitches throughout the month. Although file confirmation numbers for the successful transmission are issued, files transmitted on 7/10, 7/25 and 7/26 may have been “lost” by EDI. It appears the system glitch caused several files to be accepted by EDI but the files were never transferred over to Medicaid for processing. Medicaid has no record of the affected files. If you were anticipating receiving a check on 8/4/06, please call Provider Check Inquiry to determine if you are getting paid. If you are not getting paid and are an Expert Billing client, please call us to let us know so we can follow up. If you are not a client of Expert Billing and are affected by this issue, you can contact EDI at 800-829-0218 to determine your course of action. 7/22/06 Gatekeeper Update Failure On the weekend of 7/22/06, the Gatekeeper failed to update. This means that if providers were anticipating billing on 7/24/06 for authorization changes or approvals that occurred the week of 7/17-7/21 will have claims their denied. The update was did not work properly causing those week’s changes not to be passed over to the Gatekeeper on 7/22/06. Claims can be rebilled on 7/31/06. Please contact Expert Billing if this affected your claims. 6/01/06 3% Rate Increase for Providers An increase has been approved by the State legislature for providers. Most providers will be receiving a 3% rate increase and support coordinators will be receiving an 8% increase. The increase is anticipated to be effective 7/1/06; however, final details have not been released.
1/16/06 Daily Respite Denials We have just learned that AHCA has updated their system to only pay 30 days per year to comply with the guidelines in the Handbook. This will cause claims to deny if more than 30 days of respite have been paid in the previous 12 months. We believe this is an error and that the system should be paying respite according to the cost plan year. Please be patient and notify us if you receive denials. Once we hear that the system has been corrected, we can resubmit the denied claims. For providers that are billing on their own, contact your local district to determine your course of action. Update 2/9/06 AHCA should have their system corrected by 2/17/06 at which time denied claims can be rebilled. 1/25/06 Changes in billing limitations In Home Supports Quarter Hour: there is now a limitation of 992 quarter hours for the month. This equates to 32 quarter hours per day for up to 31 days per month. If you are billing more than 32 quarter hours per day, you need to contact your support coordinator to request approval for the daily rate. Residential Nursing: there is now a limitation of 96 quarter hours per line. This means that claims with more than 96 quarter hours will have to be billed day by day. Respite Qtr Hr: there is now a limitation of 96 quarter hours per line. This means that claims with more than 96 quarter hours will have to be billed day by day. CBA levels 1, 2 and 3 – the maximum billing limit is now 16 quarter hours per day for a combination of all 3 services BSA – maximum billing limits are now 64 quarter hours per day 1/10/06– HIPAA Compliance Deadline April 2006 Effective April 2006, Florida Medicaid's HIPAA contingency plan will expire. On this date, all claims must be submitted in the approved X12 format. Any claims not submitted in the approved format will be rejected. Providers that are using Expert Billing are assured that their claims are being submittd in the approved X12 fomat and will not have any problems. Providers that are billing on their own, or who are unsure if their claims are being submitted in the correct format, should contact EDI support to determine their course action. 1/1/06 - Mandatory Re-Enrollment Completed The re-enrollment process has now been completed. It is suggested you contact Provider Enrollment at 800-377-8216 to verify that your re-enrollment paperwork was processed and there are no outstanding issues if you have not already done so. If you have not called to verify your status and you do not get paid for January claims, it is likely your number was terminated on 12/31/05. You should contact Provider Enrollment to determine your course of action. 11/5/05 – 8% Rate Increase Effective 11/1/05 for Transportation Providers Transportation providers should be aware that there was an 8% rate increase approved effective 11/1/05. If you have not received a new service authorization, please contact your support coordinator immediately to request one. You should receive two new authorizations: one that ends 10/31/05 which will show the changes made to the current authorization and one that starts 11/1/05 which will be for the number of trips left in the plan.
Please be aware that because transportation is only approved for 480 trips for a cost plan year, when the new rates were calculated, an average of 40 trips per month was used. This has caused some plans to be short for the plan ending 10/31, because depending on the number of days in a month, you may have billed more than 40 trips at one time. In the end, it should all equal itself out because of the limitation of 480 trips for the year. If it doesn’t, you should contact your support coordinator to notify them that you do not have enough funding for the entire cost plan period. 10/15/05 – Unexpected Gatekeeper Denials Expert Billing has recently discovered that the Gatekeeper has not been getting updated regularly. The update schedule is normally set for Saturdays but over the last few months, there have been glitches in the system that caused the update not to happen regularly. This has been causing several unexpected denials. Providers that are using Expert Billing, please be patient because we are trying to be proactive on your behalf to try and anticipate when something will not pay. Unfortunately our hands are tied when it is a system issue such as this. We will continue tracking updates and rebilling as soon as possible to get your claims paid. Providers that are not using Expert Billing can contact the local district to determine your course of action. 9/29/05 – The Family and Supported Living Waiver Handbook now available online The Family and Supported Living Waiver Handbook is available online at http://apd.myflorida.com/clients/ 7/15/05 – DS Coverage and Limitations Handbook, Revised Version Effective June 2005, Now Available Online
The updated version of the DS Coverage and Limitations Handbook is now available online. The new version is effective June 2005. Providers should print a copy and review it to determine if there are any changes to the specific services rendered. Specific questions regarding any changes in the Handbook should be addressed to the local district office.
To print a copy of the Handbook, go directly to the ACS Data Exchange website (EDI). Once in the website, choose the following options from the menu on the left: 1. Click on Provider Support 3/29/05 – Request for Re-Enrollment All providers under the Developmental
Disabilities Home and Community Based Medwaiver Program are being
requested to complete a Re-Enrollment Application by ACS. It is
imperative that providers comply with the request or else the provider
will be inactivated. Fingerprints for a background screening are
also being requested. 3/1/05 – Family Supported Living (FSL) Providers - First time billing/payments When initially billing for FSL clients, please remember that you are billing under a new provider number. For new providers, the first one or two payments will be paper checks as ACS has to verify the banking information. Once the banking information has been verified, direct deposit will begin. ACS issues checks every Wednesday. You can call Provider Check Inquiry at 800-239-7560 to verify that your payment was issued. If you have further questions, you can call Provider Enrollment at 800-377-8216. 2/1/05 – Required client information for HIPAA compliant claims HIPAA compliant claims now require the following client-related data: First Name, Last Name, Address, City, State, Zip, Gender, Date of Birth, SS#. Please ensure that this information is provided to you when services are authorized by the support coordinator.
1/15/05 – The State
of Florida announced that June 30, 2005 is the deadline for accepting
non-HIPAA compliant claims
|
||||||||
|
Registered
Florida Medicaid Billing Agent |
||||||||
|
Copyright ©2004 Expert Billing & More Inc. Site Designed by: Imperial Web Solutions |
IMPORTANT
UPDATES