DHCS requires enrollment for all Medi-Cal managed care providers In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed care providers be enrolled through the Medi-Cal program. Medi-Cal managed care plans have the option to develop and implement a managed care physician screening and enrollment process that meets federal requirements, or they may direct their network physicians to enroll through the DHCS fee-for-service (FFS) enrollment portal. (Enrolling through DHCS does not obligate managed care network providers to also see FFS patients.) Some physicians have already reported receiving notices from Medi-Cal managed care ... July 11, 2018 Managed Care, Medi-Cal DHCS, Medi-Cal, Medi-Cal Provider Enrollment, Department of Health Care Services 0 0 Comment Read More »
CMA advocacy results in DHCS revaluing two CPT codes The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it was increasing reimbursement on both codes, resulting ... April 5, 2018 CMA, General, Medi-Cal Dermatology, DHCS, Economic Advoacy, Billing/Coding, CPT, Department of Health Care Services, Medi-Cal 0 0 Comment Read More »
Child Health and Disability Prevention code and claim form conversion effective July 1 The California Department of Health Care Services (DHCS) is currently transitioning Child Health and Disability Prevention (CHDP) program billing processes to be compliant with HIPAA standards for national health care electronic transactions and code sets. Rather than billing on the CHDP Confidential Screening/Billing Report (PM 160) claim form, claims will be submitted using CPT codes on the CMS 1500 or UB-04 claim forms or equivalent electronic claim transactions. The transition, effective for dates of service on or after July 1, 2017, affects claims for Medi-Cal Early and Periodic Screening, Diagnosis ... June 22, 2017 Managed Care, Medi-Cal Child Health and Disability Prevention Program, Department of Health Care Services, DHCS, HIPAA, Medi-Cal, CHDP 0 0 Comment Read More »
DHCS preps contingencies in case of delayed budget approval The California Department of Health Care Services (DHCS) recently announced it will implement a contingency plan for claim payment if the state budget is not enacted before the beginning of the 2017-2018 fiscal year on July 1. Although the state legislature passed a budget by the June 15 deadline, the Governor has not yet signed it. According to DHCS, providers should continue to submit claims for processing as normal, but payments for some programs may be delayed until the budget is signed. Claims for the following services will be processed ... June 22, 2017 General Child Health and Disability Prevention Program, Department of Health Care Services, DHCS, Family PACT, Medi-Cal, California State Budget, CHDP 0 0 Comment Read More »
CMS erroneously warns some physicians of 2017 meaningful use penalties Providers who attested to meaningful use with the Medi-Cal Electronic Health Record (EHR) Incentive Program for program year 2015 are exempt from Medicare payment adjustments in 2017. Because the California Department of Health Services pushed back the deadline to submit meaningful use applications for the 2015 program year to December 13, 2016, the agency was not able to send information to the Centers for Medicare and Medicaid Services (CMS) regarding 2015 Medi-Cal meaningful use attestations until late in December 2016. For this reason, some Medi-Cal providers are now erroneously ... February 13, 2017 Medi-Cal, Medicare Department of Health Care Services, EHR, Meaningful Use, Medi-Cal, Medicare, CMS 0 0 Comment Read More »
DHCS suspends planned passive enrollment for duals project The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment. Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. ... June 8, 2016 Managed Care, Medi-Cal, Medicare Medi-Cal, Medicare, Cal-MediConnect, Department of Health Care Services, Dual Eligible 0 0 Comment Read More »
Last chance to appeal payments under ACA primary care physician rate increase The California Department of Health Care Services (DHCS) announced that it would provide a 90-day appeal window for physicians who believe they were not paid, or paid incorrectly, under the Affordable Care Act’s (ACA) primary care rate increase. In late February 2016, DHCS announced a streamlined appeal process, which opened on March 1. The appeal window is only available under the following conditions: The provider successfully attested for the ACA incentive by December 31, 2014 For previously paid Medi-Cal claims For ... April 12, 2016 General Affordable Care Act, Department of Health Care Services, DHCS, ACA 0 0 Comment Read More »
DHCS urges providers to attest for Medi-Cal meaningful use before December 14 The California Department of Health Care Services (DHCS) announced yesterday that after December 14, 2015, it may be required to stop accepting new Medi-Cal meaningful use attestations due to changes in the federal regulations governing the Medi-Cal Electronic Health Records Incentive Program. It is urging all newly attesting Medi-Cal providers to file before December 14, 2015. DHCS said it might be required by the Centers for Medicare and Medicaid Services to stop accepting meaningful use attestations from professionals and hospitals; it is unclear when meaningful use attestations would be reopened. This ... December 21, 2015 Medi-Cal DHCS, Meaningful Use, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
Medi-Cal to use ICD-10 crosswalk for claims payment The California Department of Health Care Services (DHCS) did not convert from ICD-9 to the ICD-10 coding system by the federally mandated October 1, 2015, conversion date. DHCS has received approval from the Centers for Medicare and Medicaid Services to take incoming claims coded with ICD-10 codes and convert them back to ICD-9 using a crosswalk in order to calculate payments. DHCS reports the crosswalk is a temporary workaround until the department is able to transition to a new claims processing system. The California Medical Association (CMA) has requested that DHCS ... October 14, 2015 Medi-Cal DHCS, ICD-10, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
California State Auditor releases report outlining flaws with Medi-Cal program The California State Auditor’s office released a report on Tuesday expressing a need for better monitoring of the health plans participating in California’s Medicaid program, Medi-Cal, in order to improve beneficiaries’ access to care. Among the key findings of the audit was that the California Department of Health Care Services (DHCS), which administers Medi-Cal, “has not consistently monitored health plans to ensure that they meet beneficiaries’ medical needs—it did not perform any annual medical audits before 2012 and performed medical audits on less than half of the health plans in ... June 26, 2015 Medi-Cal DHCS, Medi-Cal, Network Adequacy, Provider Networks, Department of Health Care Services 0 0 Comment Read More »
