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Providers are responsible for informing their billing agency for information in this bulletin
In This Issue

Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Monday, May 29, 2000 in observance of Memorial Day.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Fee Schedules, Reimbursement Plans and Medicaid Bulletin Subscriptions

Request for Paper Schedules/Plans

There is no charge for fee schedules or reimbursement plans requested from the Division of Medical Assistance. However, all requests for publications should be made on the Request for Paper Schedules/Plans Form  and mailed to the following address below, or you can fax your request as indicated:

PLEASE NOTE: PHONE REQUESTS ARE NOT ACCEPTED

Division of Medical Assistance
Financial Operations - Fee Schedules
2509 Mail Service Center
Raleigh, N. C. 27699-2509

You may fax your request to (919) 715-0896/ DMA Financial Operations.

Do not mail your requests for paper schedules to EDS.
 

Request for Diskette of Physician Fee Schedule and Anesthesia Base Units Schedule

The PHYSICIAN FEE SCHEDULE and the ANESTHESIA BASE UNIT SCHEDULE are available on diskette or via email from DMA at no charge. The North Carolina Division of Medical Assistance stipulates that the information provided be used only for your internal analysis. The actual billed amount on your claims must always contain your regular billed amount and not the price on the fee schedule unless the listed price represents what you normally bill another payer or patient. The billed amount is considered during rate setting efforts.

Request for Diskette of Physician Fee Schedule and Anesthesia Base Units Schedule Form
 

Medicaid Bulletin Subscriptions

N. C. Medicaid bulletins are mailed to all enrolled providers. Non providers (e.g. billing agencies) may subscribe to the bulletin for an annual subscription fee of $12.00. To subscribe, send a letter including the subscriber's mailing address and a check for $12.00 payable to EDS to:

EDS
Attention: Provider Enrollment
P. O. Box 300009
Raleigh, N. C. 27622

DMA - Financial Operations for fee schedules and/or reimbursement plans at 919-857-4015 or
EDS - Provider Enrollment for Bulletin Subscriptions, at 1-800-688-6696 or 919-851-8888

Attention: All Providers

Accessing Hospice Participation Information on Automated Voice Response (AVR) System

Effective May 1, 2000, Hospice stickers are no longer required on Medicaid ID Cards. Hospice participation information can be determined through the AVR system by dialing 1-800-723-4337 and following the call flow as provided below.

When a provider calls the AVR system, the AVR responds with one of the following messages.

If the system is unavailable, the provider receives the following message:

"Thank you for calling EDS. The North Carolina Medicaid voice inquiries system is unavailable between 1:00 AM and 5:00 AM on the 1^st, 2^nd, 4^th, and 5^th Sunday of the month, and between 1:00 AM and 7:00 AM on the 3^rd Sunday of the month. Please try your call again later."

If the system is available, the provider receives the following greeting:

"Thank you for calling the EDS Voice Response System. Please listen carefully, our menu options have been modified since (last modify date)."

"Welcome to the EDS voice inquiry. For North Carolina Medicaid inquiries, please press 1. If you are calling from a rotary telephone or for other business, please call 919-851-8888 or 1-800-688-6696."

If the provider presses 1, the call flow continues to Step 1.0. If no entry is made after the 10-second timeout, AVR assumes the provider is calling from a rotary phone and disconnects the caller.

"Please choose one of the following options. To verify the status of a claim, press 1. To receive provider check write information, press 2. To verify drug coverage, press 3. To verify procedure code pricing and modifier information, press 4. To verify prior approval, press 5. To verify Recipient Eligibility and Coordination of Benefits, Managed Care and Hospice status, press 6. To verify the status of a hysterectomy statement or sterilization consent, press 7. If you are calling for pre-admission certification, please call (919) 851-8888 or 1(800) 688-6696. To repeat these options, press 9."

When the provider selects option 6 in Step 1.0, main menu, the AVR prompts the provider to enter their North Carolina Medicaid provider number for verification.

"Please enter your provider number followed by the pound sign (#)."

The system asks the caller to verify their entry. The system then validates the given provider number. If the caller has correctly entered a valid provider number, AVR speaks the following message.

"To verify Recipient Eligibility and Coordination of Benefits, press 1. To verify Hospice Eligibility, press 2. To repeat these options press 3."

When the provider selects option 2, the AVR prompts the provider to enter a valid recipient identification number (MID).

"To obtain recipient Hospice status, please enter the ten-digit recipient identification number followed by the pound sign (#).

The AVR validates the entry for 9 numeric digits followed by an alpha. The system then asks the caller to verify their entry. Once the caller verifies their entry, AVR prompts the provider to enter the date of service.

"Please enter the date of service in an eight-digit month, date, century, and year format, followed by the pound sign (#)."

The AVR will validate that the MMDDCCYY entry is a valid date and that it is not a future date. If the user enters an invalid date, the standard error message will be given. If the user enters a future date, AVR will speak the following message.

"Hospice status cannot be obtained for future dates. Please re-enter the date of service."

If the user enters a valid date, the system will verify the entry. After the user verifies the entry, the system will play the following message:

"Please wait while the requested information is retrieved."

The system will then retrieve the information from the host. If the recipient identification number is not valid the caller will hear the following message:

"The recipient, (MID), is not on file."

If the MID is valid and the recipient is on Hospice for the requested date of service, AVR will speak the following message:

"The recipient, (MID), has been reported on Medicaid Hospice for (MMDDCCYY - the specified date). Medicaid Hospice covers most care related to a terminal illness; therefore, Hospice participation may affect your ability to be paid by Medicaid. Ask the recipient or the recipient's representative to give you the name of the hospice agency. Contact the hospice agency before rendering service."

If the MID is valid and the recipient is not on Hospice for the requested date of service, AVR will speak the following message:

"The recipient, (MID), has NOT been reported on Medicaid Hospice for (MMDDCCYY - the specified date). Nevertheless, if the recipient or the recipient's representative indicates possible Hospice participation, please ask the recipient or representative for the name of the hospice agency and contact the agency before rendering services. Medicaid Hospice covers most care related to a terminal illness; therefore, Hospice participation may affect your ability to be paid by Medicaid."

Once the AVR system has completed the Hospice status transaction, the provider is given the option to check another date of service, verify Hospice status for a different recipient, or return to the main menu.

"To repeat the Hospice status for this recipient, press 1. To verify another date of service for the same recipient, press 2. To verify Hospice status for a different recipient, press 3. To return to the main menu, press 8. To repeat these options press 9. To end this call, please hang up."

For further information on the North Carolina Automated Voice Response (AVR) System, please refer to the June 1999 North Carolina Medicaid Special Bulletin. Providers who have the Medicaid Community Care Manual may refer to Appendix D in the manual for information on AVR. Appendix D is a reprint of the June 1999 special bulletin.

The call flow for Option 6 has been modified to allow inquiry on recipient Hospice status, effective for dates of service on or after May 1, 2000.

EDS, 1-800-688-6696 or 919-851-8888
 

Attention: All Mental Health/Substance Abuse Providers

New Health Benefit

Effective July 1, 2000 a new preventive/early intervention mental health benefit will be available to approximately 400,000 state employees and teachers and 60,000 children enrolled in N. C. Health Choice. Medicaid will adopt this policy for recipients under the age of 21. This plan will allow children to get mental health checkups similar to annual physicals.

Billing guidelines:
Medicaid will pay for six unmanaged visits without a diagnosis of Mental Illness.

Diagnosis coding: Claims may be diagnosis coded in either of two ways: (1) only the first two visits can be coded with ICD-9-CM code 799.9 (a non-specific code) and the following four visits can be coded with "V" diagnosis codes; or (2) the first visit can be coded with diagnosis 799.9 and the rest of the visits can be coded with "V" diagnosis codes. In either case, a specific diagnosis code should be used as soon as a diagnosis is established. After the sixth visit, a definitive diagnosis must be submitted in order for claims to be processed.

Prior approval:
Prior approval is not required for area mental health centers, however physicians and Ph.D. or Masters-level psychologists employed by physicians and who are not employed by area mental health centers must follow prior approval guidelines. Beyond the six unmanaged visits Medicaid will cover without a diagnosis of mental illness, Medicaid will cover up to 20 additional visits without prior approval. Prior approval must be requested for children under age 21 after the twenty-sixth visit. This permits a total of twenty-six unmanaged visits in a calendar year for the under 21 years of age population. This preventive mental health benefit will make it possible for children to receive services at the earliest signs of trouble.

Contact Carolyn Wiser, RN at 919-857-4025
 

Attention: Physicians and Health Departments

Medication Administration Codes

Effective with date of service July 1, 2000, the Medication Administration Code Q0124 will be replaced by medication specific CPT codes 90471-90788. There will be a grace period from July 1, 2000 to September 30, 2000 when the old or the new administration codes may be billed.

Health Check Providers must bill the Immunization Update Code W8012 for immunization administration for childhood immunizations. The CPT Therapeutic, Prophylactic, Diagnostic administration codes, 90782-90784, must be used for all other injections. W8012 can be billed with or without a separate office visit.
 

The newly covered CPT codes are:
 

CODE	ADMINISTRATION FOR
90471 "Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); one vaccine (single or combination vaccine/toxoid)	CPT Codes 90476 through 90749 (Vaccines and toxoids) For adults only. For childhood immunization use W8012. When a significant separately identifiable Evaluation and Management service is performed, the appropriate E/M service code can be reported in addition to the vaccine and toxoid administration codes.
90472 " each additional vaccine (single or combination vaccine/toxoid	List separately in addition to code for primary procedure (90471) for CPT codes 90476 through 90749 For adults only. For childhood immunization use W8012.
90782 "Therapeutic, prophylactic or diagnostic injection (specify material injected): subcutaneous or intramuscular	For administration of subcutaneous or intramuscular injections. This includes the Immune Globulins. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90783 "Therapeutic, prophylactic or diagnostic injection (specify material injected); intra-arterial	For administration of intra-arterial injections. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90784 "Therapeutic, prophylactic or diagnostic injection (specify material injected); intravenous	For administration of intravenous injections. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90788 "Intramuscular injection of antibiotic (specify)	For administration of an intramuscular injection of an antibiotic. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.

Administration codes are billable when the following conditions are met:

• The injection is the sole purpose for the visit to the physician's office.
• The injectable drug administration is not given in conjunction with chemotherapy administration.
• Codes 90782-90788 are not billed in conjunction with an office visit.

Attention: All Providers

Resubmission vs. Filing Adjustment

If one of the following EOBs is received and the validity is questionable, do not appeal by submitting an adjustment request. Please contact EDS provider services at 1-800-688-6696 or 919/851-8888. Adjustments submitted for these EOB denials will be denied with EOB 998 "Claim does not require adjustment processing, resubmit claim with corrections as a new day claim" or EOB 9600 "Adjustment denied - claim has been resubmitted. The EOB this claim previously denied for does not require adjusting. In the future, correct/resubmit claim in lieu of sending an adjustment request." (Last Revision 02/25/00)
 

0002	0003	0004	0005	0007	0009	0011	0013	0014
0017	0019	0023	0024	0025	0026	0027	0029	0033
0034	0035	0036	0038	0039	0040	0042	0041	0046
0047	0049	0050	0051	0058	0062	0063	0065	0067
0068	0069	0074	0075	0076	0077	0078	0079	0080
0082	0084	0085	0089	0090	0093	0094	0095	0100
0101	0102	0103	0104	0105	0106	0108	0110	0111
0112	0113	0114	0115	0118	0120	0121	0122	0123
0126	0127	0128	0129	0131	0132	0133	0134	0135
0138	0139	0141	0143	0144	0145	0149	0151	0153
0154	0155	0156	0157	0158	0159	0160	0162	0163
0164	0165	0166	0167	0170	0171	0172	0174	0175
0176	0177	0179	0181	0182	0183	0185	0186	0187
0188	0189	0191	0194	0195	0196	0197	0198	0199
0200	0201	0202	0203	0204	0205	0206	0207	0208
0210	0211	0213	0215	0217	0219	0220	0221	0222
0223	0226	0227	0235	0236	0237	0240	0241	0242
0244	0245	0246	0247	0249	0250	0251	0253	0255
0256	0257	0258	0270	0279	0282	0283	0284	0286
0289	0290	0291	0292	0293	0294	0295	0296	0297
0298	0299	0316	0319	0325	0326	0327	0356	0363
0364	0394	0398	0424	0425	0426	0427	0428	0430
0435	0438	0439	0452	0462	0465	0505	0511	0513
0516	0523	0525	0529	0536	0537	0548	0553	0556
0557	0558	0559	0560	0569	0572	0574	0575	0576
0577	0578	0579	0580	0581	0584	0585	0586	0587
0588	0589	0590	0593	0604	0607	0609	0610	0611
0612	0616	0620	0621	0622	0626	0635	0636	0641
0642	0661	0662	0663	0665	0666	0668	0669	0670
0671	0672	0673	0674	0675	0676	0677	0679	0680
0681	0682	0683	0685	0688	0689	0690	0691	0698
0732	0734	0735	0749	0755	0760	0777	0797	0804
0805	0814	0817	0819	0820	0822	0823	0824	0825
0860	0863	0864	0865	0866	0867	0868	0869	0875
0888	0889	0898	0900	0905	0908	0909	0910	0911
0912	0913	0916	0917	0918	0919	0920	0922	0925
0926	0927	0929	0931	0932	0933	0934	0936	0940
0941	0942	0943	0944	0945	0946	0947	0948	0949
0950	0952	0953	0960	0967	0968	0969	0970	0972
0974	0986	0987	0988	0989	0990	0991	0992	0995
0997	0998	1001	1003	1008	1022	1023	1035	1036
1037	1038	1043	1045	1046	1047	1048	1049	1050
1057	1058	1059	1060	1061	1062	1063	1064	1078
1079	1084	1086	1087	1091	1092	1152	1154	1156
1170	1175	1177	1178	1181	1183	1184	1186	1197
1198	1204	1232	1233	1275	1278	1307	1324	1350
1351	1355	1380	1381	1382	1400	1404	1442	1443
1502	1506	1513	1866	1868	1873	1944	1949	1956
1999	2024	2027	2235	2236	2237	2238	2335	2911
2912	2913	2914	2915	2916	2917	2918	2919	2920
2921	2922	2923	2924	2925	2926	2927	2928	2929
2930	2931	2944	3001	3002	3003	5001	5002	5201
5206	5216	5221	5222	5223	5224	5225	5226	5227
5228	5229	5230	6703	6704	6705	6707	6708	7700
7701	7702	7703	7704	7705	7706	7707	7708	7709
7712	7717	7733	7734	7735	7736	7737	7738	7740
7741	7788	7794	7900	7901	7904	7905	7906	7907
7908	7909	7910	7911	7912	7913	7914	7915	7916
7917	7918	7919	7920	7921	7922	7923	7924	7925
7926	7927	7928	7929	7930	7931	7932	7933	7934
7935	7936	7937	7938	7939	7940	7941	7942	7943
7944	7945	7946	7947	7948	7949	7950	7951	7952
7953	7954	7955	7956	7957	7958	7959	7960	7961
7962	7963	7964	7965	7966	7967	7968	7969	7970
7971	7972	7973	7974	7975	7976	7977	7978	7979
7980	7981	7982	7983	7984	7985	7986	7987	7988
7989	7990	7991	7992	7993	7994	7996	7997	7998
7999	8174	8175	8326	8327	8400	8401	8901	8902
8903	8904	8905	8906	8907	8908	8909	9036	9054
9101	9102	9103	9104	9105	9106	9174	9175	9180
9200	9201	9202	9203	9204	9205	9206	9207	9208
9209	9210	9211	9212	9213	9214	9215	9216	9217
9218	9219	9220	9221	9222	9223	9224	9225	9226
9227	9228	9229	9230	9231	9232	9233	9234	9235
9236	9237	9238	9239	9240	9241	9242	9243	9244
9245	9246	9247	9248	9249	9250	9251	9252	9253
9254	9256	9257	9258	9259	9260	9261	9263	9264
9265	9266	9267	9268	9269	9272	9273	9274	9275
9291	9295	9600	9611	9614	9615	9625	9630	9631
9633	9642	9684	9801	9804	9806	9807	9919	9947
9993

EDS, 1-800-688-6696 or 919-851-8888
 

Attention: All Physicians

Correction To Injectable Drug List

Effective with date of service April 1, 2000, the following correction is made to the fee for Daunorubicin Citrate Liposome 10 mg, J9151. The fee listed in the April Medicaid Bulletin was for the previous dosage of 50 mg which was the dosage for the state code W5163.
 

New Code	Description	Fee
J9151	Daunorubicin Citrate Liposome 10 mg	$61.37

EDS, 1-800-688-6696 or 919-851-8888
 
 

Attention: Dental Providers

New Dental Claim Form and Code Updates for the Year 2000

The American Dental Association (ADA) has updated the ADA claim form and the Current Dental Terminology Users Manual for the year 2000. The ADA recommended use of the 1999 ADA claim form beginning in January, 2000. While keeping in compliance with the ADA changes, DMA and EDS must allow time for system changes to be implemented before accepting the 1999 ADA claim form. Providers should continue to use the 1994 ADA claim form for North Carolina Medicaid. DMA and EDS are working on the necessary system changes that must occur before acceptance of the 1999 form. Our anticipated implementation date for the 1999 ADA claim form is July 1, 2000. A transition period of three months will allow the 1994 and the 1999 claim forms to be accepted from July 1, 2000 through September 30, 2000.

Note: See a sample of the 1999 ADA claim form .

Updates to the Current Dental Terminology Users Manual contain revised procedure code descriptions, procedure code deletions, and new ADA procedure code additions. DMA and EDS strive to use codes in accordance with the ADA; however, providers should continue to submit the procedure codes identified in the North Carolina Medicaid Dental Services Manual until further notification. DMA and EDS are working on the necessary system changes that must occur before the new procedure codes will be implemented. The anticipated implementation date for the new ADA procedure codes is also July 1, 2000.

Watch upcoming Medicaid Provider Bulletins for exact dates and additional information regarding implementation of the 1999 ADA claim form and 1999 ADA code updates.
 

EDS, 1-800-688-6696 or 1-919-851-8888  
 

Attention: All Providers

Pap Smear Billing Changes

Based on recommendations to align with Medicare, the following policy changes are effective with date of service June 01, 2000 when billing Pap smears:

Physician Interpretation Procedure Code and Billing Information

CPT 88141 is the only code that physicians may use to bill the physician interpretation of a Pap smear. Because code 88141 has no components, it must be billed without a modifier. For dates of service June 1, 2000 and after, code 88141 appended with modifier 26 will be denied. Hospitals billing for the physician interpretation should bill 88141 on the HCFA-1500 claim form using the hospital's professional provider number.

Technical Pap Smear Component Procedure Codes and Billing Information

The technical procedure codes are listed below. The provider rendering the technical service must choose a technical procedure code from one of the following methods:
 

Thin Layer	Non-Bethesda	Bethesda	Not Specified
88142 88143 88144 88145	88150  88152 88153  88154	88164 88165 88166 88167	88147 88148

Laboratories and physicians: Bill the technical component procedure code without a modifier on the HCFA-1500 claim form.

Hospitals: Bill the technical component procedure code, without a modifier, using Revenue Code (RC) 311 on the UB-92 claim form.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Nursing Facility Providers

Discharge of a Nursing Facility Resident

When a Nursing Facility resident requires hospitalization, the Nursing Facility provider must indicate a discharged status in form locator 22 and a discharged bill type in form locator 4 on the UB-92 claim form. Nursing Facility claims billed incorrectly are subject to recoupments.

EDS, 1-800-688-6696 or 919-851-8888
 

Attention: Physicians, Health Departments, Nurse Practitioners, Nurse Midwives, Rural Health, and FQHC Providers

Implantable Contraceptive Capsules

Effective with date of service July 1, 2000, all physicians will bill the Current Procedural Terminology (CPT) codes for the Implantable Contraceptive Capsules (previously referred to as Norplant). There will be a grace period from July 1, 2000 to September 30, 2000 when the Implantable Contraceptive Capsules may be billed using state created codes or CPT codes. The state created codes that will be end-dated with date of service October 1, 2000 are:

W5131 Insertion procedure Norplant system
W5132 Removal procedure Norplant system
W5133 Removal and re-insertion plus Norplant System kit

The following CPT/HCPCS codes will be used for physician billing on the HCFA-1500 claim form:

CPT 11975 "Insertion, implantable contraceptive capsules".
CPT 11976 "Removal, implantable contraceptive capsules".
CPT 11977 "Removal with reinsertion, implantable contraceptive capsules".
A4260 " Levonorgestrel (contraceptive) implant system, including implants and supplies".

The global period for the procedure codes are one (1) pre-care day and ninety (90) post-operative days.

Reminder: Please indicate "F" in item 24H on the HCFA-1500 claim form or append modifier "FP" to the procedure code to indicate Family Planning.

Hospital expenditures for the contraceptive kit and needed supplies will be included in the DRG for the procedure.

The Division of Medical Assistance sought clarification from the Attorney General's Office with respect to the capacity of minors to consent to the use of the implantable contraceptive capsules. The General Statute is as follows:

General Statute 90-21.5. Minor's consent sufficient for certain medical health services.

(a) Any minor may give effective consent to a physician licensed to practice medicine in North Carolina for medical health      services for the prevention, diagnosis and treatment of (i) venereal disease and other diseases reportable under G.S. 130A-135, (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional disturbance. This section does not authorize the inducing of an abortion, performance of a sterilization operation, or admission to a 24 hour facility licensed under Article 2 of Chapter 122C of the General Statutes except as provided in G.S. 122C-222. This section does not prohibit the admission of a minor to a treatment facility upon his own written application in an emergency situation as authorized by G.S. 122C-222

(b) Any minor who is emancipated may consent to any medical treatment, dental and other health services for himself or for his child.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Home Health Providers

HCPCS Codes for Skilled Nursing Visits

Several questions were asked at the February Home Health Provider Seminars regarding the appropriate HCPCS code that should be used to describe certain skilled nursing visits. This article provides clarification for providers who were not in attendance when the questions were asked.

1. Q. For supply-only patients, what code should be used to describe the 60-day RN assessment visit to ensure the patient is receiving the appropriate medical supplies?
   A. W9958 (Home Health skilled nursing visit not otherwise classified).
2. Q. Our agency provides monthly skilled nursing visits to CAP/DA clients - which we refer to as "CAP
   assessment visits." What code should be used?
   A. Medicaid guidelines do not include a service identified as a "CAP assessment visit." Home Health services to CAP clients are based on the same criteria used for all Medicaid recipients. There are no special exemptions or allowances for CAP recipients. When billing for a skilled nursing visit, determine if the purpose of the visit is described on the MEDICARE-Medicaid Billing Guide in Section 5 of the Medicaid Community Care Manual. If Medicare covers the visit, bill Medicare. When Medicare does not cover the visit, determine if the monthly visit to a CAP recipient meets the description in Item A.4 on the chart. This visit is for observation and evaluation after a period with no significant changes in intervention - the patient's condition is chronic but stable yet there continues to be a documented medical necessity for intermittent nursing visits. In such situations, W9952 is the appropriate code and the limits on the chart apply. When a need for a Medicare-covered intervention is identified, MEDICARE becomes the primary payer.
3. Q. If more than one skilled nursing task/activity described on the chart is provided during the same visit, such as prefilling a medi-planner and prefilling insulin syringes, which code is used?
   A. First, determine if either activity meets Medicare coverage guidelines. If so, bill the visit to Medicare. If Medicare does not cover the visit, then determine which Medicaid HCPCS code to use based on the code that describes the most important skilled nursing activity in relation to the patient's health and well-being. If the activities appear equal in importance, use your best judgement to select the code. The HCFA-485 and your clinical documentation should support your HCPCS code selection.
4. Q. When documentation supports that wound care no longer meets Medicare criteria for a dually-eligible patient, which code should be used to bill Medicaid?
   A. In rare cases when Medicare does not cover wound care, use W9958 (Home Health skilled nursing visit not otherwise classified). Before billing Medicaid, pay special attention to instructions in the note in C.13 on the MEDICARE-Medicaid Billing Guide, page 5-20, Section 5, Community Care Manual.
    

Attention: Hospice Providers

Frequently Asked Questions (FAQ's) About the Hospice Participation Reporting Requirements

This article gives the answers to the most frequently asked questions regarding the new Hospice participation reporting requirements.
 

1. Q. Do I need to report when one of my patients dies?
   A. No. The patient's date of death is put in the system through the Eligibility Information System.
2. Q. I have a patient who has elected the Hospice Medicaid benefit; however, their Medicaid is still pending. When do I call to report their election?
   A. When you encounter this situation, you will need to make two telephone calls to the EDS Prior Approval unit.
   1. Make the initial call when the patient elects Hospice within the six-day time frame.
   2. Once the patient's Medicaid is approved call EDS and let them know this patient was previously reported as a pending Medicaid patient. EDS will then give you a confirmation number that dates back to your original telephone call.
3. Q. I have a Medicaid Hospice patient whose next benefit period starts next Monday. I am sure the patient will re-elect Hospice. Because I will be on vacation next week, I would like to call the election in on Friday. May I do so?
   A. No. You may not call in the election of a new benefit period until the date the patient re-elects Medicaid Hospice.
4. Q. Our Hospice admitted a patient on March 1, 2000. The office manager was out of town and could not call the election in until March 14, 2000. Can we get a retroactive confirmation number?
   A. No. Hospice agencies must make sure they have a procedure to report all patients within the six-day grace period.
5. Q. I have a patient with Medicare and Medicaid. The patient has elected both Medicare and Medicaid Hospice. The patient is at home and Medicaid will never be billed. Do I need to call this patient's information to EDS?
   A. No. It is not necessary to call EDS unless you are planning on billing Medicaid.
6. Q. The patient who has elected Medicare and Medicaid Hospice has now decided to enter a nursing home.  Our agency will need to begin billing Medicaid for the room and board. When do we need to call EDS for a confirmation number?
   A. You must call EDS within six days of the patient's admission to the nursing home. The benefit start date will be the date the patient entered the nursing home and the benefit end date will coincide with the end date for the current Medicare benefit period.
   
    

EDS 1-800-688-6696 or 919-851-8888

Attention: OB/GYN Providers

OB/GYN Seminar Schedule

Seminars for OB/GYN providers are scheduled in June 2000. Business office managers, Medicaid billing supervisors, and other billing personnel should plan to attend. These seminars will review program guidelines, coding, claim form completion, and follow-up, and will also focus on the most common denials for this provider type. Electronic claims submission will also be discussed as it is encouraged to facilitate faster claims payment.

Due to limited seating, pre-registration is required. Providers not registered are welcome to attend if reserved space is adequate to accommodate.

Please select the most convenient site and return the completed registration form to EDS as soon as possible. Seminars begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive by 9:45 a.m. to complete registration.

Directions

Tuesday, June 6, 2000 Four Points Sheraton 5032 Market Street Wilmington, NC	Thursday, June 15, 2000 Catawba Valley Technical College Highway 64-70 Hickory, NC Auditorium
Tuesday, June 20, 2000 Holiday Inn Conference Center 530 Jake Alexander Blvd., S. Salisbury, NC	Monday, June 26, 2000 WakeMed  MEI Conference Center 3000 New Bern Avenue Raleigh, NC Park at East Square Medical Plaza

(registration form only)

OB/GYN Provider Seminar Registration Form

Directions to the OB/GYN Seminars

WILMINGTON, NORTH CAROLINA

FOUR POINTS SHERATON

I-40 East into Wilmington to Highway 17 - just off I-40. Turn left onto Market Street and the Four Points Sheraton is located approximately ½ mile on the left.

RALEIGH, NORTH CAROLINA

WAKEMED MEI CONFERENCE CENTER

Directions to the Parking Lot:

Take the I-440 Raleigh Beltline to New Bern Avenue, Exit 13A (New Bern Avenue, Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road and park at the East Square Medical Plaza which is a short walk to the conference facility. Parking is not allowed in the parking lot in front of the Conference Center. Vehicles will be towed if not parked in the East Square Medical Plaza parking lot located at 23 Sunnybrook Road.

Directions to the Conference Center from Parking Lot:

Cross Sunnybrook Road and follow sidewalk access up to Wake County Health Department. Walk across the Health Department parking lot and ascend steps (with blue handrail) to MEI Conference Center. Entrance doors at left.
 
  SALISBURY, NORTH CAROLINA

HOLIDAY INN CONFERENCE CENTER

Traveling South on I-85: Take exit 75 and turn right on Jake Alexander Blvd. Traveling North on I-85: Take exit 75 and turn left on Jake Alexander Blvd. Travel approximately ½ mile and the Holiday Inn is located on the right.

HICKORY, NORTH CAROLINA

CATAWBA VALLEY TECHNICAL COLLEGE

Take I-40 to exit 125 and go approximately 1/2 mile to Highway 70. Travel East on Highway 70 and the college is approximately 1.5 miles on the right. Ample parking is available. Entrance to Auditorium is between the Student Services and the Maintenance Center. Follow sidewalk (toward Satellite Dish) and turn right to Auditorium Entrance.

Attention: Hospital Providers

Hospital Seminars

Hospital seminars are scheduled in July 2000. The June Medicaid Bulletin will have the registration form and a list of site locations for the seminars. Please send any issues you would like addressed at the seminars to the following address:

Provider Services
EDS
P.O. Box 300009
Raleigh, NC 27622

EDS, 1-800-688-6696 or 919-851-8888

Attention: Physicians

Injectable Drug Fee Change

Effective with date of service May 1, 2000, the maximum allowable fee has been changed for the following injectible drugs:
 

J1020	Methylprednisolone Acetate 20 mg	$2.29
J1030	Methylprednisolone Acetate 40 mg	$4.59
J1040	Methylprednisolone Acetate 80 mg	$9.17

EDS, 1-800-688-6696 or 919-851-8888

Attention: Hospital Providers

ICD-9 Procedure Code 47.09

The September 1999 Medicaid Bulletin, page 11, published a list of noncovered services for providers. ICD-9-CM Procedure Code 47.09 (other appendectomy) was listed as noncovered. Effective with date of service November 1, 1999, DMA implemented coverage of Procedure Code 47.09 for abdominal appendectomy when the diagnosis code reflects appendicitis.

EDS, 1-800-688-6696 or 919-851-8888
 

Checkwrite Schedule

May 9, 2000	June 13, 2000	July 11, 2000
May 16, 2000	June 20, 2000	July 18, 2000
May 23, 2000	June 29, 2000	July 27, 2000
May 31, 2000

 

Electronic Cut-Off Schedule

May 5, 2000	June 9, 2000	July 7, 2000
May 12, 2000	June 16, 2000	July 14, 2000
May 19, 2000	June 23, 2000	July 21, 2000
May 26, 2000

Electronic claims must be transmitted and completed by 5:00 p.m. on the cut-off date to be included in the next checkwrite. Any claims transmitted after 5:00 p.m. will be processed on the second checkwrite following the transmission date.