DHCS announces additional delays for some ACA Medi-Cal primary care rate increases September 19, 2014 Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, CHDP 0 The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via a one-time spreadsheet upload without the need for individual claim inquiry forms. Spreadsheets must be submitted by October 1, 2014, to receive retroactive payments based upon the uploaded claims information. Providers who do not upload claims information before October 1, 2014, will receive claims payments based solely on original claims information or by submitting individual claim inquiry forms. For more information, see the DHCS bulletin. DHCS also recently announced it will issue interim estimated payments for these retroactive claims in October with a final true up EPC to occur in December. CHDP claims – Some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lessor of Medicare’s rate or the billed charges—that some practices would not qualify for the increase. At CMA and other stakeholders' urging, DHCS agreed to a workaround to allow these practices to be paid at the higher rates. DHCS is working on a web application that will allow a onetime submission of the physician's usual and customary amount, which will allow the practice to receive the higher reimbursement intended by the rate increase. DHCS recently announced it intends to make an interim payment on CHDP claims in December. The true up will occur during the 2015 calendar year. Crossover Claims (Medi/Medi claims) – As previously reported, the Centers for Medicare and Medicaid Services (CMS) agreed with CMA and has required DHCS to modify its proposed bundled code methodology for crossover claims, as it would have consistently underpaid physicians anytime they billed a code eligible for the increase with any other codes that are not eligible. DHCS anticipates the necessary system enhancements will be made in time for checks to be issued in December. According to DHCS, the clean-up process to address all exceptions and reconciliation of the estimated dollars previously released, has been delayed from August to December, 2014. Managed care payments Many physicians report they have begun receiving payments from their Medi-Cal managed care plans, while others report they have not. According to DHCS, some plans have only received additional monies for part of calendar year 2013. Some plans that haven’t yet received any funds will receive their outstanding monies for calendar year 2013 with their upcoming October capitation cycle check. No plans have received increased payments for calendar year 2014 because they are still awaiting CMS approval. DHCS will issue 2014 monies to the plans for distribution once the CMS approval is received. Providers are encouraged to work with their medical groups or health plans directly regarding the distribution of these monies. There's still time to attest! According to DHCS, eligible physicians who have already attested have received over $283 million in ACA primary care rate increases. Don't miss out! Remember, to qualify for the payment increases, you must first self-attest to your eligibility. The deadline to attest is December 31, 2014. Practices with questions can call Medi-Cal’s Telephone Service Center at (800) 541-5555. If you have attested and not received your additional funds for fee-for-service Medi-Cal patients, practices are encouraged to confirm the accuracy of the information submitted through the attestation process. Contact: Kristine Marck, (916) 551-2037 or kmarck@cmanet.org. Comments are closed.
