DCH-i [Vol. 2, no. 6 (July 2013)]

July 2013 Volume 2, Issue 6

Retroactive ACA Physician Rate Increase Attestation Deadline Extended to August 31, 2013

Follow Us!

The Georgia Department of Community Health (DCH) has extended the attestation deadline to August 31, 2013, for providers to receive a retroactive pay bump for the ACA Provider Rate Increase. The Patient Protection and Affordable Care Act (ACA) mandates a rate increase for certain primary care practitioners from January 1, 2013, through December 31, 2014.

Best Practices Research Participants
Needed

Attest Now! The increased rates will be retroactive for services billed on or after January 1, 2013, for providers who attest by August 31, 2013. For providers who attest on September 1, 2013, or after, reimbursement will only be made back to the first of the month in which the provider attested.
The Georgia Department of Community Health (DCH) began the self-attestation process on April 1, 2013, through the Georgia Medicaid Management Information System (GAMMIS) portal at www.mmis.georgia.gov.
Attention Eligible Primary Care Providers. These include board-certified physicians with a specialty designation of family medicine, general internal medicine and/or pediatric medicine or an associated sub-specialty, including allergists. If providers do not meet the board-certification requirement, they may be eligible for the rate increase if they self attest that at least 60 percent of their Medicaid billings and services are for evaluation and management (E&M) codes listed in the final rule.

In This Issue
Deadline Extended for Retroactive ACA Physician Rate Increase
Medicaid Enrollment Required for OPR Providers
ICD 10: Ready, Set, Test
Changes for Children in Foster Care
Input Sought for November 21 Medicaid Fair
Attention Primary Care Providers: Best Practices
EHR Incentives

Providers will not need to attest with each Care Management Organization (CMO) separately; DCH will share provider eligibility files with each Medicaid CMO.
Physician extenders, including physician assistants, nurse practitioners and nurse midwives, are also eligible provided they practice under the direct supervision of an eligible physician with professional responsibility for the care provided.
For More Information. Additional updates and notifications will be posted to the DCH website (www.dch.georgia.gov/provider-news) and the GAMMIS portal (www.mmis.georgia.gov) and will be sent to providers and associations.
If you have policy questions, please send them to gapcplus@dch.ga.gov. If you have enrollment questions, please send them to EnrollmentACARateIncrease@dch.ga.gov.

About DCH-i
DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important
information to you as physicians, dentists, hospitals,
third-party payers, vendors, health care advocates,
consumers and legislators. Our goal is to help create A
Healthy Georgia -- together. Write us at
DCH-i@dch.ga.gov.

Medicaid Enrollment Required for Ordering, Prescribing and Referring (OPR) Providers
If you're currently ordering, prescribing or referring on behalf of Medicaid beneficiaries, but you do not file claims to Medicaid, the Patient Protection and Affordable Care Act (ACA) now requires that you enroll in the Medicaid Program as an OPR Provider. Your NPI number must also be included on the claim from the participating Medicaid provider. Otherwise, the participating (or rendering) provider filing the claim cannot be paid. The Georgia Department of Community Health (DCH) is alerting physicians and other providers of this new rule and began accepting applications for these OPR providers as of April 1, 2013.
Starting later this year, claims for services that contain a National Provider Identification number (NPI) of an Ordering, Prescribing, or Referring provider not enrolled in Medicaid (either as a participating provider or as an OPR provider) will be denied. Providers already enrolled as active Medicaid participating providers do not need to enroll again as OPR providers. Georgia Medicaid requires that NPIs for OPR providers be included on all claims.
DCH has created an expedited and streamlined enrollment process for OPR providers. Additionally, OPR providers will not be required to submit financial documentation or complete certain sections of the application that pertain to claims or payee information.
Enrolling as an OPR Provider:
Does not obligate you to see Medicaid patients; Does not mean you will be listed as a Medicaid provider for patient assignment or referral; and Does help to ensure that your orders, prescriptions and referrals for Medicaid patients are accepted, processed and paid appropriately.
Pharmacy Claims -- Take Note! Beginning August 1, 2013, DCH will edit pharmacy claims for the presence of an enrolled OPR provider. Pharmacies will be notified through the claims transaction if the submitted prescribing provider is not enrolled with DCH as either an OPR or rendering provider. Beginning October 1, 2013, pharmacy claims will be denied if the prescribing provider is not enrolled as OPR or rendering provider with DCH.
All Other Claims -- Take Note! DCH will begin OPR editing for claims for all other categories of service later this year. OPR providers should enroll now in Medicaid through the Georgia Medicaid Management Information System (GAMMIS) Web Portal at www.mmis.georgia.gov. OPR providers may submit a paper application in lieu of completing an online application. The paper application (with instructions) can also be found on the GAMMIS portal.
Listings of enrolled OPR providers can be viewed and downloaded at www.mmis.georgia.gov. Click on Provider Information/Reports. Additional information may be found in the Frequently Asked Questions (FAQ) document that will be posted soon at www.mmis.georgia.gov (Provider Information/FAQ for Providers). For questions, please contact Hewlett-Packard Enterprise Services (HPES) at 800-766-4456, press option #0. You can also send an e-mail to OPREnrollment@dch.ga.gov.

Do you have a question or a comment? Tell us what's on your mind at DCH-i@dch.ga.gov.
About DCH
Through effective planning, purchasing and oversight, the
Department of Community Health (DCH) provides access
to affordable, quality health care to millions of Georgians, including some of the state's
most vulnerable and underserved populations.
DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit
Plan, Healthcare Facility Regulation and Health Information Technology in
Georgia. Clyde L. Reese III is the DCH
Commissioner. We are dedicated to A Healthy Georgia. www.dch.georgia.gov
Editor-in-Chief Pamela A. Keene
Circulation Denise L. Smith Director of Communications and Legislative Affairs Lisa Marie Shekell Deputy Director of Communications
Peg Woodruff

Ready, Set, Test?
DCH Webinars on ICD-10 Can Help You Finish Strong
Small Practice Readiness? A Clinical Close-up? Medicaid Policy Update? Pre-Testing Readiness? Troubleshooting?
These topics and more will help you with the federally mandated transition to ICD-10 coming in 2014. Plus, we always welcome your questions at the end of each session.
Please remember that space is limited to the first 500 attendees for the live presentation of each webinar,* so we encourage you to register today and be sure to join each webinar early. Once your registration has been received, a confirmation e-mail will be sent to you with the log-in information and WebEx tips to make sure your system is compatible.
To register for any of the ICD-10 webinars below, please visit the DCH website at www.dch.georgia.gov/IT-Events.
To view any of our ICD-10 webinars at your convenience, please visit the DCH website at www.dch.georgia.gov/ITEvents for a link to the on-demand webinar presentation posted within 48 hours of the live presentation.
Upcoming ICD-10 2013 Webinars -- Register NOW!
August 15 -- 10:30 a.m. Topic: ICD-10 Clinical Close-up Sept. 10 -- 10:30 a.m. Topic: Medicaid Policy Update & ICD-10 Sept. 17 -- 10:30 a.m. Topic: Trading Partners --Testing Readiness with DCH Sept. 25 -- 10:30 a.m. Topic: Providers -- Testing Readiness with DCH Oct. 15 -- 10:30 a.m. Topic: Pre-Testing Readiness & Troubleshooting Oct. 29 -- 10:30 a.m. Topic: Open Discussion, Q&A on ICD10
The above dates and topics are subject to change.
* Webinar space is limited to the first 500 attendees for the live webinar (including video and audio capability). If more than 500 attendees try to join a live webinar event, they will receive a prompt indicating the event is closed to additional attendees. However, a recording of the live event (including video and audio) will be available "on demand" within two business days of the live event. The recorded webinars can be found on the DCH website at www.dch.georgia.gov/IT-events.

DCH Mission
We will provide Georgians with access to affordable quality health care through effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.

Medicaid to Improve Continuity of Care for Children in Foster Care and Other Vulnerable Populations
Children and Youth Will Transition to a Single Statewide CMO
As part of the redesign of the Georgia Medicaid Program, the Department of Community Health (DCH) will transition approximately 27,000 children in foster care and adoption assistance, as well as select youth in the juvenile justice system, to a single care management organization (CMO) for their health care coverage. The transition is effective on January 1, 2014. Moving these populations to a designated CMO will result in improved care coordination, continuity of care and better health outcomes for the enrollees. DCH has selected Amerigroup Community Care as the designated CMO.
DCH has been working with the Centers for Medicare & Medicaid Services (CMS) to determine the appropriate federal authority to achieve the transition of these populations. CMS has determined that the department can submit a State Plan Amendment to address the inclusion of the members in foster care, adoption assistance and juvenile justice into the single CMO.
DCH posted a public feedback survey, conducted two public meetings and has reopened its opinion mailbox (MyOpinion@dch.ga.gov) to gather input and feedback from stakeholders, which will be used to provide additional information and guidance as the program is further developed and implemented.
New DCH Commissioner Clyde L. Reese III, Esq., has been involved in the plans to move children in foster care and adoption assistance in his role as former commissioner of the Georgia Department of Human Services (DHS).
"This is an exciting time for all our child-serving agencies in Georgia and for the care of these young people who are often in transient situations," Reese said. "Having been part of this process since the redesign began, I can certainly see the benefits of moving these populations into a single CMO."
In an exceptional collaboration, seven state child-serving agencies have come together for this transition -- the Department of Community Health, the Department of Human Services, the Department of Behavioral Health and Developmental Disabilities, the Department of Public Health, the Department of Juvenile Justice, the Department of Education, and the Department of Early Care and Learning. These state agencies bring a focused commitment to the transition and added emphasis on outreach, education and communication with key stakeholders: members, caregivers, foster parents, adoptive parents and providers.

Topic Input Sought for November 21 Medicaid Fair
Mark your calendars for the Thursday, November 21, Medicaid Fair in Dalton, Ga. The day-long event will feature knowledgebased sessions for all providers, focusing on new billing, ICD10, audits and reviews, and hospitals. There will also be an opportunity to meet with the care management organizations to talk about claims issues.
What topics would you like to see included in this Medicaid Fair? What are your specific questions for our expert presenters? Send us your input by August 23, 2013, to DCHi@dch.ga.gov.
Check for updates and the link to the registration form at the Georgia Medicaid Management Information System (GAMMIS) website at www.mmis.georgia.gov.
Attention Primary Care Providers
Better Practices, Best Practices. Which is Yours?
Tell Us About Your Best Practices. We know that you use "best practices" in your office every day and we want to learn more about those practices.
We also want to share what we learn with all Georgia Medical Assistance Plan practitioners. After all, doesn't practice make perfect -- or at least make things a whole lot better? Click on the research link below to answer questions like these:
Does your practice use incentives with Medicaid and CHIP members to encourage/reinforce positive healthy behaviors? How do you ensure that your patients keep their appointments ? How do you accommodate same-day sick visits? And what about "no show" appointments? How do you keep your members informed and educated about their health-related issues? How does your practice address excessive ER visits for non-emergent care?
Take Our Survey Now. It will take less than 10 minutes and all responses will be confidential and anonymous. The Performance, Quality and Outcomes Unit of the Medical Assistance Plans Division of the Department of Community Health appreciates your input to this survey. Please respond before August 18, 2013. Survey link: http://www.surveymonkey.com/s/T8GXHZL
More than $153 Million Paid in EHR Incentives
Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $153 million in payments of federal funds to eligible providers through July 15, 2013.
The program was launched on September 5, 2011.