November 2013 Client Newsletter
Medicaid Primary Care Incentive Payments Set to Begin
The New Jersey Division of Medical Assistance and Health Services (DMAHS) announced in its October newsletter that traditional Medicaid retroactive payments for the primary care incentive will be made in bulk payments and processed by mid-December 2013. Incentive payments will begin processing on a claim by claim basis as of November 4, 2013. Under Traditional Medicaid, physicians had until April 30, 2013 to file attestation forms in order to receive retroactive incentive payments going back to January 1, 2013. Physicians who submit the attestation after April 30th will receive incentive payments starting from the first day of the month the attestation was submitted. For example, if the attestation is submitted on October 17, 2013, then the incentive payments will apply to claims starting October 1st. Please note: the fee-for-service deadline does not apply to physicians in the Medicaid Managed Care Organizations (MCO); a deadline should be provided directly from the plan. Let us know if you need assistance if you are not already signed up.
CPB clients have begun to receive these payments. Once caught up with retroactive payments, the MCO incentive payments will be made in quarterly bulk payments and will not be claim specific. MSNJ would like to know if your practice encounters any issues with these incentive payments by writing to them at info@msnj.org with "Medicaid Incentive" in the subject line.
Request from MSNJ– Insurance Audits
“Payers are auditing practices more frequently with an eye toward recovering overpayments, detecting fraudulent, wasteful or abusive billing practices, or simply correcting billing and coding errors. Services that are not documented are deemed to not have occurred and payers are monitoring for these deficiencies. All payers, government and private, have developed post- and pre-payment audits to detect coding errors, correct billing practices, and recover payments.
MSNJ is concerned that many physicians may not be aware that they are in a post- or pre-payment review. When coding errors continue through a post-payment audit the practice will be placed in pre-payment review. When coding errors continue in pre-payment the practice is at risk for referral to the payer's fraud unit and the state's fraud office. Physicians are urged to ask their billing staff if claims are being routinely denied and if the practice is in a payment review.
If you are currently in a payment review please write to info@msnj.org, put "Payment Review" in the subject line, and describe your situation. They have been working with payers in an effort to make these reviews more transparent and meaningful to physician practices. They also plan a series of webinars to provide further information.â€
Presumptive Eligibility Program at NJ Medicaid.
Patients with Medicaid Presumptive Eligibility coverage indicated she is an undocumented alien who is pregnant. The program is funded by the State which allows very limited funding for pre-natal care for undocumented aliens. Care for this type of patient is restricted to being rendered in a hospital or clinic that is registered for this program, not in a provider’s office. No payment will be issued for service in a provider’s office due to the restrictions of this patient’s program.
The way to identify a patient enrolled in the Presumptive Eligibility program is that the first 5 digits of the ID# will begin with: 1330-94, 1330-95, 1330-96, 1330-97, or 1330-98.
Your staff can call Molina Medicaid or the Presumptive Eligibility Unit at 609-588-2911 prior to seeing a patient to confirm a patient’s eligibility and get program details when they see the ID#s beginning with the ID numbers listed above.
Small Business Health Option Program (SHOP)
The Department of Health and Human Services (HHS) is ramping up their efforts to reach out to small businesses in an effort to make small employers (and their employees) aware of new options available to them under the Affordable Care Act.
In conjunction with the Small Business Administration (SBA), the HHS campaign will try to help small employers learn more about how to take advantage of the Small Business Health Option Program (SHOP). SHOP is designed for small employers with 50 or fewer full-time employees.
Employers buying health insurance through the SHOP Marketplace may also qualify for a Small Business Health Care Tax Credit to help defray their premium costs. Small businesses with fewer than 25 full-time-equivalent employees may be eligible for a federal tax credit of up to 35 percent of their contribution to employees’ health insurance premiums. Beginning in 2014, this tax credit will be worth as much as 50 percent of the employer’s contribution to premiums and will be available only to those purchasing coverage through the SHOP. To learn more about the tax credits, go to small employer tax credit (http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers ) and see if you qualify.
The SHOP Marketplace opened on Oct. 1st. Small employers can go to www.healthcare.gov and start the application process and get an overview of available plans and premiums in their area. The SHOP is different from the Individual Marketplace so be sure to access the appropriate section of the state or federal website.
Beginning Oct. 1st, HHS began taking calls (Monday through Friday, 9 a.m. to 7 p.m. EST) through a dedicated SHOP small employer call center at 1-800-706-7893. Employers may contact the call center for assistance when completing an application. This call center will also refer employers in states running their own SHOP Marketplace to the correct contact information for their state.