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2012 Medicaid Bulletin Index

Medicaid bulletin articles and special bulletins organized by provider type for 2012.

All Providers:

• 340b Purchased Drugs, 8/12
• 2013 Checkwrite Schedule, 10/12
• Appeals for Outpatient Specialized Therapies Policy Tiered Limits, 12/12
• At-Risk Case Management Services (ARCM) for Eligible N.C. Health Choice (NCHC) Beneficiaries, 9/12, 12/12
• Basic N.C. Medicaid and N.C. Health Choice Seminars, 4/12, 5/12, 8/12, 9/12, 10/12
• Bevacizumab (Avastin, HCPCS Procedure Code J9035) Update to Billing Guidelines
  • 1/12
  • 4/12
  • 5/12
• Behavioral Health Services Provided in Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC), 11/12
• Billing Reminder for CPT Code 36415, 10/12
• Changes in the Medicaid Beneficiary Fair Hearing Process (Appeal Process), 9/12
• Changes in Medicaid Prior Approval Policies and Procedures, Recipient Due Process (Appeals), and EPSDT Seminar, 6/12, 8/12
• Change to N.C. Medicaid Identification Card, 4/12
• Clarification of the Division of Health Service Regulation Good Standing Status, 7/12
• Clinical Coverage Policies: 4/12, 5/12, 6/12, 7/12, 8/12, 9/12, 10/12, 12/12
• CMS’ Stage 2 Final Rule for EHR Incentive Program Affects Eligible Professionals, 12/12
• Communicating Effectively with Deaf, Hard of Hearing and Deaf-Blind Patients and Family Members in Healthcare Settings, 9/12
• Correct Coding Edits: Adjusting the Number of Units for Submitted Claims, 5/12, 7/12
• Correct Coding Edits: Implementation of Additional Edits for Professional Duplicates, 6/12, 7/12, 8/12
• CPT Code
  • Update 2012, 1/12
  • CPT Code 93278, 9/12
  • CPT Code 97598 (Unit Limitations), 9/12
  • CPT Code 11044 - DMA Global Days Different from Medicare, 11/12
• Decommission of Modem Service, 11/12, 12/12
• Delay of Required Enrollment for Physician Assistant and Nurse Practioners, 6/12
• EHR Incentive Program announces NC PATH, 8/12
• EHR Incentive Program Attestation Tail Period Clarification, 11/12
• EHR Incentive Program: Clarifying PA-Led, Practice Predominantly, and “Incident To” Billing, 8/12
• EHR Incentive Program Updates, 8/12, 9/12, 10/12
• EHR Providers Can Make Attestations under NC-MIPS, 8/12
• Electronic Health Records (EHR) and Meaningful Use Training, 6/12
• Enrollment and Application Fees, 12/12
• Enrollment Application Status Inquiries, 4/12
• Enrollment of Nurse Practitioners, 5/12
• Enrollment of Physician Assistants, 5/12
  
• Fraud and Abuse Laws, 1/12
• HCPCS Code G0328, 1/12
• HCPCS Procedure Code Changes for the Physician's Drug Program: 4/12, 8/12
• Health Check/EPSTD Seminars, 7/12
• HIPAA ASC X12 4010 A1 and 5010 837 - Discretion Period Cutoff Date June 30, 2012, 6/12
• HIPAA ASC X12 4010 A1 and 5010 837 – Extension of Enforcement Discretion Period Through June 30, 2012, 5/12
• ICD-10 Web Page Launched, 8/12
• Implementation of Additional Correct Coding Edits: Facility Duplicates, 1/12, 12/12
• Implementation of Additional Correct Coding Edits: Professional Duplicates, 1/12
• Incorrect Billing for Therapy Visits, 4/12
• Influenza Vaccine and Reimbursement Guidelines for 2012-2013 for Medicaid and N.C. Health Choice (NCHC), 9/12
• Influenza Vaccine and Reimbursement Guidelines for 2012-2013 for Medicaid and NCHC - REVISED, 10/12, 11/12
• Injection, Gadobutrol (Gadavist™, HCPCS Code A9585): Billing Guidelines, 5/12
• Injection, Ioflupane I 123,185 MBq (DaTscan™ HCPCS Code A9584): Billing Guidelines, 5/12
• Intrauterine Copper Contraceptive (Paragard, HCPCS Code J7300) – Revised Billing Guidelines, 7/12
• Letter of Attestation, 1/12
• Loan Fund to Improve Access to Electronic Health Records, 1/12
• Maintaining the Security and Accessibility of Records after a Provider Agency Closes, 5/12
• Medicaid Providers Must Screen for Individual & Entity Exclusion, 12/12
• Medicare HMO UB-04 Claims, 12/12
• Mirena Return Process for Physicians’ Offices, 8/12
• National Correct Coding Initiative
  • Billing Guidance, 8/12, 11/12
  • Medically Unlikely Edit Denials, 4/12
  • Updated, 1/12
  • Billing Guidance, 10/12
• N.C. Health Check Seminars, 8/12, 9/12
• N.C. Health Choice (NCHC) Medical Transportation, 9/12
• N.C. Health Choice Providers with Outstanding Medical Claims with Dates of Services Prior to October 1, 2011, 4/12, 6/12, 7/12
• N.C. Health Choice Well Visits and Immunizations – Medicaid Alert, 1/12
• N.C. Medicaid Electronic Health Record (EHR), 1/12
• N.C. Medicaid Electronic Health Record (EHR) Incentive Program Audits, 7/12
• N.C. Medicaid EHR Incentive Program NC-MIPS Portal Update, 7/12
• N.C. Medicaid EHR Incentive Program’s Website – Update, 11/12
• N.C. Medicaid Provider Direct Enrollment and Screening, 8/12
• N.C. Medicaid Provider Direct Enrollment and Screening - UPDATE, 12/12
• N.C. Medicaid Providers Must Screen for Individual & Entity Exclusion, 4/12
• N.C. Medicaid Recovery Audit Contractors, 10/12, 12/12
• N.C. Medicaid Tamper Resistant Prescription Pad Guidance Update, 5/12
• N.C. Medicaid Transportation, 1/12
• New ICD-10 Deadline Set for October 1, 2014, 10/12
• Notice of Rate Adjustment , 7/12
• Office Relocation: Program Integrity, Finance, Management, Hearings, 6/12
• Outpatient Specialized Therapies, 1/12,
• Outpatient Specialized Therapies, Adult Therapy, 6/12
• Outpatient Specialized Therapies: Reminder of Documentation Requirements, 6/12
• Payment Error Rate Measurement (PERM) in North Carolina, 8/12, 10/12
• Prior Approval for Procedure Codes 41010, 41115 and D7960, 6/12
• Prior Approval for Procedure Codes 41010, 41115, 41520, D7960 and D7963, 7/12
• Procedures for PA Request for Synagis for RSV Season 2012-2013, 10/12
• Processing Changes for Duplicate Remittance and Status Reports (RAs), 10/12, 12/12
• Provider Enrollment Fee, 1/12
• Provider Self-Audit Protocol, 4/12, 5/12
• Provider Verification for Non-Emergency Medical Transportation (NEMT) Program, 7/12
• Radiology Unlisted Procedure Codes, 4/12
• Recipient Eligibility Verification Tools, 7/12
• Recredentialing for N.C. Medicaid Program, 6/12
• Recredentialing is Required for All N.C. Medicaid and N.C. Health Choice Providers a Minimum of Every Three Years, 9/12, 10/12, 12/12
• Reinstatement of CPT Code 80100, 4/12
• Replacement MMIS - NC Tracks Information, 4/12
• Reporting Managing Relationship Changes, 8/12, 12/12
• Resolving Denied Claims – HPES Call Center, 11/12
• Review for Institute for Mental Disease (IMD) Determination Update, 10/12
• Session Law 2011-399 Senate Bill 496- 108C-7 Prepayment Claims Review, 4/12, 5/12
• SPECIAL BULLETIN - Electronic Health Records (EHR) Incentive Program (Oct. 2012 - Updated version of bulletin originally published in June 2012)
• Submitting Provider Refunds, 1/12
• Subscribe and Receive Email Alerts for Medicaid Updates, 4/12, 11/12, 12/12
• System Changes From the Annual CPT Update 2012, 9/12
• Termination of Inactive N.C. Medicaid and N.C. Health Choice Provider Numbers, 8/12, 10/12, 12/12
• Ultrasounds Removed from the PA Requirement, 4/12
• Update on Bundled Prospective Payment System (PPS) for End Stage Renal Disease, 8/12
• Updated EOB Code Crosswalk to HIPAA Standard Codes, 5/12, 11/12
• Update for Prior Approval of Imaging Procedures and MedSolutions, 9/12
• Visual Evoked Potential, 4/12

Adult Care Home (ACH) Providers

• Consolidated PCS Policy Update, Independent Assessments and New Admission Reporting for Consolidated PCS, Submission of 1915(i) Alzheimer’s Services Benefit Application, Provider Training Schedule, 10/12
• Transition to 1915(i) Personal Assistance Services, 6/12
• SPECIAL BULLETIN - Transition Planning for Implementation of Consolidated Personal Care Services, 7/12
• Transition and Implementation Update, Personal Care Services, 12/12
• Transition Planning for Implementation of Consolidated Personal Care Services, 8/12
• Transition Planning and Implementation Update, Personal Care Services, 11/12
• Update on Independent Eligibility Assessments for Consolidated Personal Care Services, 9/12

Ambulatory Surgical Centers

• National Correct Coding Initiative - Billing Guidance, 6/12, 7/12

CAP Providers

• CAP Assure Website Changes, 6/12
• November 2012 - Special Bulletin - Money Follows the Person: Information about Pre-Transition and Transition Services
• Extension of Current CAP-MR/DD Waiver and Process for Submitting Authorization Requests, 1/12
• Implementation of Updated Rates, 9/12
• Money Follows the Person: An Introduction, 9/12
• Quality Improvement Strategies for CAP/DA 1915(c) HCBS Waiver, 10/12
• Renewal of the Community Alternative Program for Disabled Adults 1915 (c) HCBS Waiver, 12/12
• SPECIAL BULLETIN - CAP I/DD Waiver Approval, Process for Submitting Authorization Requests, and Appeal Rights, 10/12

Case Management Agencies:

• Money Follows the Person: An Introduction, 9/12

Community Care of N.C./Carolina ACCESS:

• Carolina ACCESS Referral/Authorization Guidelines, 11/12

Critical Access Behavioral Health Agencies (CABHA's):

• Behavioral Health CPT Code Update 2013, 11/12
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• Questions and Answers from the November 2011 Outpatient Seminars, 1/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Dental Providers

• Dental Providers Must Be Enrolled in N.C. Medicaid Program in Order to Participate, 12/12
• Dental Services and Medicaid for Pregnant Women (MPW) Eligibility, 10/12

Dialysis Providers

• Billing Guidelines: Peginesatide, 6/12
• Clarification about Filing to N.C. Medicaid, 8/12, 11/12

Durable Medical Equipment Providers:

• 2012 HCPCS Code Changes, 1/12
• Certificates of Medical Necessity and Obtaining Override Requests, 6/12
• N.C. Health Choice (NCHC) Durable Medical Equipment Requests Through Provider Link, 12/12
• Place of Service for Durable Medical Equipment, 12/12
• Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs, 1/12
• Roche ACCU-CHEK Diabetic Supplies Program – Override Extended Until April 30, 2012, 4/12
• Roche Provider Rebates, 6/12
• Webinar Training, 4/12, 5/12

Enhanced Behavioral Health (Community Intervention) Services Providers:

• Behavioral Health CPT Code Update 2013, 11/12
• Education Related to Trends Identified in Program Integrity Post-Payment Reviews, 4/12
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Federally Qualified Health Centers (FQHC):

• Behavioral Health Services Provided in Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC), 11/12

Health Department Dental Centers

• Dental Services and Medicaid for Pregnant Women (MPW) Eligibility, 10/12
• Dental Providers Must Be Enrolled in N.C. Medicaid Program in Order to Participate, 12/12

HIV Case Management Providers:

• HIV Case Management under the N.C. Health Choice Program, 6/12
• Training Announcements, 1/12, 5/12

Hospice Providers

• Hospice Services Policy Prior Approval Requirements, 11/12
• Hospice Benefit Period Information Accessible on AVR System and NCECSWeb Tool, 8/12

Hospitals

• Clarification on CMS Guidance around Medicaid Attestations for Eligible Hospitals, 9/12
• CMS’ Stage 2 Final Rule for EHR Incentive Program Affects Eligible Hospitals, 12/12
• EHR Incentive Program: Eligible Hospital Payment Calculation, 8/12
• EHR Eligible Hospital (EH) Payment Calculation Information and Required Documentation, 10/12
• Hospital Cost Report Instructions for Fiscal Year Ending June 30, 2012, 11/12
• Money Follows the Person: An Introduction, 9/12
• Use of RC Coding for Emergency Room Charges, 7/12

Hospital Outpatient Clinics

• Clarification of April 2012 Article on Hospital Outpatient Therapies, 6/12

Hospital Providers:

• Coding for Ventricular Assist Devices Before New Policy was Published on November 1, 2011, 4/12

IDD Providers

• Behavioral Health CPT Code Update 2013, 11/12
• SPECIAL BULLETIN - 1915 (c) Innovations Waiver Expansion, 10/12
• SPECIAL BULLETIN - CAP I/DD Waiver Approval, Process for Submitting Authorization Requests, and Appeal Rights, 10/12

Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF-I/DD)

• Money Follows the Person: An Introduction, 9/12

Independent Diagnostic Testing Facility (IDTF):

• IDTF Billing Information and List of Procedure Codes, 5/12

In-Home Care Providers

• Consolidated Personal Care Services Implementation Update, 12/12
• Consolidated Personal Care Services Policy Update, Submission of 1915(i) Alzheimer’s Services Benefit Application, Upcoming Provider Trainings, 10/12
• Consolidated Personal Care Services Implementation Update, 11/12
• Proposed Clinical Coverage Policy 3L Posted for Public Comment, 8/12
• Transition Planning for Consolidated Personal Care Services Program, 9/12

Institutional (UB-04) Billers

• New Submission Address for Medicare HMO Claims, 6/12, 8/12
• UB-04 Claim forms for Medicare HMOs, 6/12

Laboratories

• Clinical Laboratory Improvement Amendments of 1988 (CLIA) Recertification Procedures, 9/12

Local Management Entities:

• Behavioral Health CPT Code Update 2013, 11/12
• Clarification of the Division of Health Service Regulation Good Standing Status, 7/12
• Extension of Current CAP-MR/DD Waiver and Process for Submitting Authorization Requests, 1/12
• Money Follows the Person: An Introduction, 9/12
• SPECIAL BULLETIN - CAP I/DD Waiver Approval, Process for Submitting Authorization Requests, and Appeal Rights, 10/12

N.C. Health Choice Providers:

• Allergy Shots Are Not Exempt from Recipient Cost Sharing Obligations, 7/12
• Behavioral Health Services Provided in Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC), 11/12
• Billing for Immunizations for American Indian and Alaska Native N.C. Health Choice Recipients, 6/12
• Co-Pay Clarification, 11/12
• Implanon/Nexplanon and Other Family Planning Denials, 12/12
• Influenza Vaccine and Reimbursement Guidelines for 2012-2013 for Medicaid and N.C. Health Choice (NCHC), 9/12
• Influenza Vaccine and Reimbursement Guidelines for 2012-2013 for Medicaid and NCHC - REVISED, 10/12, 11/12
• NC Health Choice Claims Processing Transition, 1/12
• NC Health Choice Providers with Outstanding Medical Claims with Dates of Services Prior to October 1, 2011, 4/12
• NC Health Choice Well Visits and Immunizations – Medicaid Alert, 1/12, 5/12, 8/12
• NC Medicaid and Health Choice Antipsychotics Programs Pharmacy POS Override Code Protocol, 4/12
• Point of Sale Override for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 1/12
• Subscribe and Receive Email Alerts for Medicaid Updates, 4/12, 11/12

Nursing Facility Providers

• Money Follows the Person: An Introduction, 9/12

Nurse Practitioners

• Billing Guidelines - Revised: Pralatrexate, 6/12
• Carfilzomib (Kyprolis, HCPCS code J9999): Billing Guidelines, 10/12
• Pertuzumab (Perjeta, HCPCS Code J3590): Billing Guidelines, 9/12
• Prescribing and Documenting Brand Medically Necessary Drugs, 6/12
• Ranibizumab (Lucentis, HCPCS Code J2778): Update to Billing Guidelines, 11/12
• Taliglucerase alfa (Elelyso, HCPCS code J3590):  Billing Guidelines, 9/12
• Ziv-aflibercept (Zaltrap), HCPCS code J9999): Billing Guidelines, 11/12

Orthotics and Prosthetics Providers:

• 2012 HCPCS Code Changes, 1/12
• Roche ACCU-CHEK Diabetic Supplies Program – Override Extended Until April 30, 2012, 4/12
• Webinar Training, 4/12, 5/12

Outpatient Behavioral Health Service Providers

• Behavioral Health CPT Code Update 2013, 11/12
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Pharmacists:

• Automatic Refills and Automatic Shipments No longer Allowed, 1/12
• Benzodiazepines and Barbiturates are No Longer Covered for Dual Eligible Beneficiaries, 12/12
• N.C. Medicaid and Health Choice Antipsychotics Programs Pharmacy POS Override Code Protocol, 4/12
• N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List Changes, 11/12
• N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List Changes, 11/12
• New Prior Authorization Requirements for Incivek, Victrelis, Kalydeco, and Cialis, 11/12
• Point of Sale Override for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 1/12
• Prescribers not Enrolled in Medicaid, 12/12
• Prescribing and Documenting Brand Medically Necessary Drugs, 6/12
• Revised Prior Authorization Requirements for Leukotriene Modifiers, 11/12
• Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs, 1/12
• Upcoming Policy Implementation: Off Label Antipsychotic Safety Monitoring in N.C. Health Choice Recipients, 1/12
• Upcoming Policy Implementation: Off Label Antipsychotic Safety Monitoring in Recipients 18 and Older, 1/12

Physician Assistants

• Billing Guidelines - Revised: Pralatrexate, 6/12
• Carfilzomib (Kyprolis, HCPCS code J9999): Billing Guidelines, 10/12
• Pertuzumab (Perjeta, HCPCS Code J3590): Billing Guidelines, 9/12
• Prescribing and Documenting Brand Medically Necessary Drugs, 6/12
• Ranibizumab (Lucentis, HCPCS Code J2778): Update to Billing Guidelines, 11/12
• Taliglucerase alfa (Elelyso, HCPCS code J3590):  Billing Guidelines, 9/12
• Ziv-aflibercept (Zaltrap), HCPCS code J9999): Billing Guidelines, 11/12

Physicians

• Affordable Care Act Enhanced Payments to Primary Care Physicians, 10/12, 11/12
• Affordable Care Act Enhanced Payments to Primary Care Physicians - UPDATE, 12/12
• Behavioral Health CPT Code Update 2013, 11/12
• Billing Guidelines - Revised: Pralatrexate, 6/12
• Carfilzomib (Kyprolis, HCPCS code J9999): Billing Guidelines, 10/12
• Clarification Regarding Psychiatric Billing, 7/12
• Pertuzumab (Perjeta, HCPCS Code J3590): Billing Guidelines, 9/12
• Prescribing and Documenting Brand Medically Necessary Drugs, 6/12
• Ranibizumab (Lucentis, HCPCS Code J2778): Update to Billing Guidelines, 11/12
• Sipuleucel-T (PROVENGE, HCPCS Code Q2043): Billing Guidelines, 9/12
• SPECIAL BULLETIN - Transition to 1915(i) Personal Assistance Services, 6/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12
• Taliglucerase alfa (Elelyso, HCPCS code J3590):  Billing Guidelines, 9/12
• Ziv-aflibercept (Zaltrap), HCPCS code J9999): Billing Guidelines, 11/12

Prescribers:

• Benzodiazepines and Barbiturates are No Longer Covered for Dual Eligible Beneficiaries, 12/12
• N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List Changes, 11/12
• Prescribers not Enrolled in Medicaid, 12/12
• Revised Prior Authorization Requirements for Leukotriene Modifiers, 11/12
• New Prior Authorization Requirements for Incivek, Victrelis, Kalydeco, and Cialis, 11/12

Private Duty Nursing (PDN) Providers

• Clinical Coverage Policy 3G, Private Duty Nursing – Update, 12/12

Professional Billers:

• N.C. Medicare Override Function via the NCECSWeb Tool, 5/12

Psychiatric Hospitals

• Authorization Requests by Psychiatric Inpatient Acute Care Providers, 7/12
• Behavioral Health CPT Code Update 2013, 11/12
• Certificates of Need (CON) for Free-standing Psychiatric Hospitals Serving People Under the Age of 21 and PRTF, 7/12
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Psychiatric Residential Treatment Facilities (PRTF)

• Authorization Requests by Psychiatric Inpatient Acute Care Providers, 7/12
• Behavioral Health CPT Code Update 2013, 11/12
• Certificates of Need (CON) for Free-standing Psychiatric Hospitals Serving People Under the Age of 21 and PRTFs
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Residential Child Care (RCC) Treatment Facility

• Behavioral Health CPT Code Update 2013, 11/12
• Extension of Coverage for Provisionally Licensed Providers Billing Outpatient Behavioral Health Services Through Local Management Entities, 7/12
• SPECIAL BULLETIN- Behavioral Health and I/DD Updates, 6/12
• SPECIAL BULLETIN - Treatment of Confidential Information under N.C.G.S. §122C, 7/12

Rural Health Centers (RHC):

• Behavioral Health Services Provided in Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC), 11/12

Targeted Case Management for Individualas with Intellectual and Developmental Disabilities:

• Extension of Current CAP-MR/DD Waiver and Process for Submitting Authorization Request, 1/12