Health Safety Net Updates. Massachusetts Health Care Training Forum January 2018

Transcription

1 Health Safety Net Updates Massachusetts Health Care Training Frum January 2018

2 HSN Updates Agenda Updates t HSN Regulatins Billing Updates MassHealth Carrier Cdes Occupatinal Therapy Cdes Span Dates n Claims Reprting Patient Paid Amunts and HSN Deductible amunts n 837I claims Billing Reminders HSN Fiscal Year Clsings HSN and Billing Intermediary (BI) Changes HSN Waiver Requests Medical Hardship Eligibility Prvider requirements Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 1

3 Updates t HSN Eligibility Regulatins (101 CMR 613) Scheduled t g in effect n sner than February 1, Prpsed changes include: N lnger requiring 340B prviders t carve in MassHealth in rder t be paid by the HSN fr drugs prvided t HSN patient Allwing the HSN t pay fr certain 340B drugs that may be excluded frm cverage thrugh the 340B Drug Pricing Prgram fr MassHealth members under anticipated MassHealth regulatins Requiring prviders t give 90 day written ntice requiring their intent t discntinue prviding utpatient pharmacy services t Health Safety Net patients Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 2

4 Updates t HSN Eligibility Regulatins (101 CMR 613) Scheduled t g in effect n sner than February 1, Prpsed changes include: Clarifying current HSN rule regarding asset reprting. Under these prpsed regulatins, if MassHealth requests a verificatin f assets frm an applicant fr health cverage, the individual must cmply with the request in rder t cntinue t qualify fr HSN Allwing prviders t bill a patient t allw the patient t meet bth the CmmnHealth ne-time deductible and MassHealth spend dwn requirements utlined by MassHealth A public hearing abut these prpsed regulatins was held n January 10th, 2018 Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 3

5 Billing Update: MassHealth Carrier Cdes Prviders shuld cntinue t plan t transitin t utilizing the MassHealth Carrier Cdes fr all secndary/tertiary claims Once implemented, failure t use the crrect carrier cdes n a claim will result in a denial Mre detailed infrmatin abut using these cdes, MassHealth and CMSP cdes, and the effective implementatin date will be sent t prviders in the future Billing Update: Occupatinal Therapy Cdes Acute Outpatient Hspital Prviders that submitted the new OT cdes , 97166, and received a denial at MMIS shuld submit these denied claims as new riginal claims Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 4

6 Billing Update: Span Dates n Claims HSN will accept span dates f services n ne claim, effective fr dates f services 12/1/2016 frward the same effective date as MassHealth guidance If submitting span dates n ne claim, prviders must be sure that each date is indicated fr services at the line level Billing Update: Reprting Patient Paid Amunts and HSN Deductible Amunts n 837I Hspital Claims Any remaining HSN Deductible Amunt that has yet t be paid by a patient shuld begin t be reprted using Value Cde D3 n 837I claims. If a patient has met their HSN deductible, this shuld be reprted as 0 Any Patient Paid Amunt shuld be reprted using Value Cde FC n 837I claims Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 5

7 Billing Reminder: Fiscal Year Clsings HSN FY16 HSN FY 2016 Scheduled Clsing: Prviders are reminded that HSN FY16 is scheduled t clse as f September 30, 2018 HSN FY15 HSN FY15 Clsed: Prviders are reminded that HSN FY15 is clsed as f September 30, 2017 Any FY15 claims trying t prcess beynd this date will be denied If prviders have questins n the FY15 clsing, please cntact the HSN Helpdesk at hsnhelpdesk@state.ma.us Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 6

8 Billing Reminder: Billing Intermediary (BI) Changes When a facility uses a billing intermediary fr claim submissin, please nte the fllwing: HSN claim questins frm a BI will be redirected t the facility due t the facility retaining a cntract with the BI The BI is the nly entity that has access t dwnlad Validatin Reprts frm INET (HSN denial reprts)-facilities that require claim infrmatin frm Validatin reprts will need t speak t their BI Facilities can cntact HSN regarding claim billing questins r claim payments **Please nte** Facilities utilizing a BI fr the first time r changing a BI must ntify MassHealth EDI; must als ntify HSN via in additin t filling ut an HSN Business Partner Agreement lcated in INET Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 7

9 Billing Reminder: Using a Billing Intermediary and Hw t Request with HSN When a facility utilizes a billing intermediary fr submissin f HSN claims, the fllwing steps are necessary t ensure claim adjudicatin within MassHealth and HSN: MassHealth Ntificatin Ntificatin t MassHealth cntaining the BI infrmatin via at: EDI@MAHealth.net BI infrmatin cnsists f the fllwing: On their signed letterhead please mentin that this is fr an HSN prvider Facility ID Name f BI/ MassHealth Submitter ID 835 and/r 837 files MassHealth PIDSL(s) (including HSN PID/SL) Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 8

10 Billing Reminder: Using a Billing Intermediary and Hw t Request with HSN HSN Ntificatin Ntificatin t HSN cntaining the BI infrmatin via shuld als include a cmpleted HSN Business Partner Agreement lcated n the HSN website: BI infrmatin cnsist f the fllwing: Name f BI Start date - claim submissin f BI Type f claims 837I; 837P HSN PIDSL(s) ORG ID(s) The ntificatin alng with the cmpleted HSN Business Partner Agreement shuld be sent via t HSN Helpdesk at: HSNhelpdesk@.state.ma.us Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 9

11 Billing Reminder: HSN Waiver Requests HSN has started t fllw the prcess that MassHealth uses fr billing waiver requests HSN will n lnger cnsider any three year billing waiver requests Prviders requesting 1 year, r 90 day requests, shuld cntact HSN Manager f Operatins, Angela Gizzi, (Angela.Gizzi@state.ma.us) fr instructins n requesting and prcessing f claims Billing Reminder: 90 Day Waiver Requests Prviders are reminded that when requesting a 90 day waiver, due t a prir payer, that all EOB infrmatin must be cmpleted and submitted alng with any additinal dcumentatin t EHSHSN@state.ma.us Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 10

12 HSN Medical Hardship Eligibility Individual must be a Massachusetts Resident Allwable medical expenses include paid and unpaid bills fr services prvided up t 12 mnths prir t the date f the Medical Hardship applicatin fr which the Patient is respnsible Applicant cntributin amunt is calculated based n medical expenses, family size and the family incme Individual medical expenses must exceed a specified percentage f family s incme. Individuals with incme < 400% f Federal Pverty Level must cmplete an applicatin (Massachusetts Applicatin fr Dental Cverage and Health Paying fr Csts) Incme level Percentage 0-200% FPL 10% % FPL 15% % FPL 20% % FPL 30% >601% FPL 40% Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 11

13 HSN Medical Hardship (cnt d) Hspital and CHC Prviders must Assist in cmpleting applicatin Assist and review all dcumentatin Residency Incme Detail itemized Medical Bills Invices (Including thse f any ther prviders) The INET applicatin is sent electrnically Submit package in hard cpies with signed applicatin and supprting Categry B dcumentatin t: HSN: Medical Hardship 100 Hancck Street, 6th Flr Quincy, MA HSN will ntify the applicant and relevant prviders f the determinatin, including services that HSN cannt assist (i.e. physician s ffice fees) Submit claims t HSN after apprval ntificatin f the Medical Hardship applicatin has been received Claims must submitted using 837 frmat Massachusetts Executive Office Divisin f Health f Health and Care Human Finance Services and Plicy 12

14 QUESTIONS? Massachusetts Divisin f Health Care Finance and Plicy Executive Office f Health and Human Services 13