DME Refresher. September 2016

Transcription

1 DME Refresher September

2 Overview of eqsuite system features» 24/7 accessibility to submit review requests to eqhealth via web.» Secure transmission protocols that are HIPPA security compliant.» System access control for changing or adding authorized users.» A reporting module that allows hospitals to obtain real-time status of all reviews.» Rules-driven functionality and system edits to assist Providers through immediate alerts such as when a review is not required or a field requires information.» A helpline module for Providers to submit queries.» Electronic submission of additional information needed to complete a review request. 2

3 System Requirements Minimal Computer System Requirements Any of the two most recent versions of: Internet Explorer Google Chrome Mozilla Firefox Safari Broadband Internet connection 3

4 Who can access eqsuite?» Existing Web Account Log into eqsuite using your existing username and password. o Your username and password are unique to your organization. o If you conduct reviews for 2 separate provider Medicaid numbers (i.e. therapy and med/surge you need a different username for each)» New Users: Register for a Web Account Some organizations may already have an assigned eqhealth System Administrator. This person is responsible for creating user IDs and assigning access rights to eqsuite for those who need to put in PARs. Note: If an organization does not have a System Administrator, a Provider Contact Form needs to be submitted with a System Administrator assigned. 4

5 Required Documentation Prescription Must include signature of the physician, ARNP or PA Type of DME prescribed FL professional license number or NPI number Description of the Items Is the equipment currently owned? Is the equipment rented or being purchased specifically for the recipient? Was the equipment purchased by Medicaid if so when? The age of the equipment Pricing Information Sales Invoice from the DME provider Manufacturers documents showing MSRP of requested items 5

6 Required Documentation Written Prescription One of the following are required with the request for authorization: Hospital discharge plan Certificate of medical necessity Plan of care (If the DME provider is a Home Health Agency) 6

7 Required Documentation INVOICE A list of each component and related fee described by HCPCS procedure codes on the current DME and Medical Supply Services Provider Fee Schedules The invoice subtotal A list of any components not listed on the DME and Medical Supply Services Provider Fee Schedules, its applicable HCPCS code, and the provider s requested price for each individual component The invoice total, excluding all shipping and handling fees 7

8 Example of an Invoice 8

9 Wheelchairs Wheelchair Evaluations Must support the medical necessity of all components/upgrades for the recipient Clinician recommended custom components should match the sales invoice. All information on the FL Medicaid wheelchair evaluation form must be completed by a licensed PT, OT or physiatrist Custom Wheelchairs The evaluating clinician must document the reasons as to why the custom component is medically necessary Examples: Custom wheelchair tray vs. wheelchair tray Upper extremity support surface vs. wheelchair tray Custom wheelchair cushion vs. prefabricated wheelchair cushion 9

10 Submitting Correct HCPCS Codes 10

11 HCPS Codes Patient Lifts Power Operated Vehicles Power Wheelchairs Custom Wheelchairs E0630 E0635 K0800 K0801 K0802 K0822 K0823 K0014 Custom Power wheelchair K0009 Custom Manual wheelchair K0108 Items w/ no appropriate HCPCS code K0739 Labor 11

12 Wheelchair Repair/Replacement Use HCPCS codes for each item being replaced. Only use HCPCS code K0108 for items/materials with no appropriate HCPCS code. Labor is separately billable using K0739 and is not included in the PA for the components. Note: Prior authorization for custom wheelchair repair includes repair/replacement of all needed components. 12

13 Pricing Determinations Pricing is based on AHCA maximum payment guidelines and is not negotiable. eqhealth does not have the authority to negotiate, alter, or apply any other pricing strategy. Pricing information is available prior to a medical necessity determination. This information does not guarantee approval of the request nor payment for services. 13

14 Non-Covered Items 14

15 Non-Covered Services Powered wheelchair component for standing Transit tie downs Wheelchair electronics upgrades to control or have interface with other non-covered services and exclusions Wheelchair lifts Wheelchair ramps Wheelchair sanitization service Wheelchair upgrades needed for outdoor or use outdoors at night 15

16 Non-Covered Services Car seats or car beds Computers and computer-related equipment Equipment or devices used primarily for transport Ceiling lifts that require home modification Physical fitness equipment Note: For list of additional items that are non-covered, please consult the Florida Medicaid DME Handbook 16

17 Live Demonstration 17

18 Questions? 18

19 Provider Communications Dedicated Florida Website: Web: FL.EQHS.ORG Customer Service: Ph: Monday-Friday Hours:8 a.m-5 p.m (Except Florida state holidays) Provider Outreach: 19