Billing Managers Network
In order to increase communication with clinic billing staff, CPCA has launched a new Clinic Billing Staff Network. This group will meet quarterly by conference call, beginning in October, 2009. Health center administrators are encouraged to pass this information along to their billing managers and other lead billing staff who might be interested in participating so that they can be added to our list to receive future updates. CPCA plans to utilize this group to better support clinic billing staff by sharing information in a timely manner, seeking feedback on important billing policies to support advocacy efforts with the state and providing a space for questions and discussion about issues of concern.
Update on Reimbursement Issues_05.15.12
MEI (Medicare Economic Index)
FQHCs and RHCs were approved an MEI increase of 0.4% to be effective 10/1/11. PPS rates were adjusted 3/26/12. Health centers are waiting on an EPC (Erroneous Payment Correction) to reprocess claims retro to October 1, 2011. According to ACS the anticipated implementation date for the EPC will be early June.
PPS Rate Adjustments
A&I has 36 months to audit the actual rate setting cost report which is filed by a health center after the first full fiscal year of operations. Some health centers had their finalized PPS rate approved by A&I but their claims do not reflect the new adjusted rate. According to DHCS, new and adjusted PPS rates have not been implemented since the transition to the new fiscal intermediary, ACS. ACS has shared with CPCA that they have two upcoming EPCs (Erroneous Payment Correction) for FQHC retro rate adjustments scheduled to be implemented early June. CPCA has requested a list of all the FQHCs that will be part of the rate adjustment EPCs. Once we receive a list, CPCA will share the information with the individual health centers.
60% Managed Care Reconciliation Settlement Payments
CPCA has recently received feedback from some health centers that they have not received their 60% reconciliation settlement payment from their current FY submission. At our last meeting with A&I we brought this issue to A&I’s attention. A&I acknowledged they have a backlog due to the temporary ruling to stop the tentative settlements which was rescinded in February 2012. According to A&I, their backlog should be reduced starting in July. Health centers can email A&I at clinics@dhcs.ca.gov to inquiry about their payment. If you are not successful with getting an answer please contact Ginger Smith at gsmith@cpca.org.
Code 19
There are several unresolved issues around Code 19. CPCA is working with the appropriate agencies to resolve the issues.
Health plan payment being deducted from the Code 19 wrap payment
· ACS has researched and recognized cuts are being made and are in the process of working with DHCS to develop of plan of correction.
Billing same day medical & dental visits
· CPCA is still working with ACS on a solution.
ID# for some healthy families patients
· Code 19 claims must have the patient’s BIC # (Benefits Identification Card) in order to be paid.
· With most Healthy Families ID#s when the alpha characters are dropped the numbers remaining are the patient’s BIC #. This isn’t the case with Health Net and a few local plans.
· CPCA is working with MRMIB to get this resolved.
· CPCA has also reached out to Health Net and requested a meeting to discuss this issue.
· In the meantime health centers can send a list to the plan requesting the patient’s BIC# so claims can be submitted.
· For more information, please contact Sonya McLean at smclean@cpca.org
Code 19 Reconciliation Process
· DHCS has drafted a letter explaining the process and will be asking CPCA to review prior to sending the letter out to providers.
· CPCA will vet the letter through some members of the CFO Peer Network for their feedback.
CPCA's 2012 Billing Managers Quarterly Call/Meeting Schedule
(Webinar/Call in information and materials will be sent out prior to each call.)
Tuesday, August 28 (2-3 pm)
Tuesday, November 13 (2-3 pm)
CPCA Staff Contact
For question regarding billing and/or coding, please contact our Senior Coordinator for FQHC Billing & Coding, Sonya McLean at smclean@cpca.org or 916.440.8170.
