DCH-i [Vol. 2, no. 7 (Aug. 2013)]

August 2013 Volume 2, Issue 7

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Hours Remain to Attest for Retroactive ACA Physician Rate Increase
Attest by August 31 on GAMMIS
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. Payments are scheduled to begin in November.
Attest Now! The increased rates will be retroactive for certain services billed on or after January 1, 2013, for providers who attest by August 31, 2013. For providers who attest on or after September 1, 2013, reimbursement will only be made back to the first of the month in which the provider attested.
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 boardcertification 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.
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.
Providers will not need to attest with each Care Management Organization (CMO) separately; DCH will share provider eligibility files with each Medicaid CMO.
For More Information. Additional updates and notifications will be posted to the DCH website and the Georgia Medicaid Management Information System (GAMMIS) portal. DCH has also posted comprehensive FAQs.
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.

Important Dates
August 31 -- Attestation Deadline for ACA
Retroactive Payments
October 1 -- Pharmacy Denials Begin for OPR
October 1 -- Early Elective Delivery Policy
Starts
4Q 2013 -- Testing Begins for ICD-10
In This Issue Attest Now for Retroactive ACA Physician Rate Increase Are You At Risk? ICD-10 Transition Enrollment Required for OPR Providers Early Elective Deliveries Policy Begins October 1, 2013 Personal Attention: Medicaid Pediatric Boot Camp Changes Coming to SHBP for 2014 EHR Incentives August Board Actions

Providers at Risk Without Transition to ICD-10 Coding
DCH Begins External Testing with Trading Partners in Q4 2013
The Department of Community Health (DCH) and Georgia Medicaid have been preparing for the transition to ICD-10 since 2010. That's almost three years. With even more work to do here in testing, awareness building and transitioning, we thought you might appreciate a reminder or two, plus you may want to know how your peers are doing. (No pressure, but a much-needed boost perhaps?)
A Reminder -- The Risks of ICD-10 Non-Compliance
Your claims will be rejected or denied if you submit an ICD-9 code for services rendered on or after October 1, 2014. Claims backlogs may occur and claims resolution issues with HP/DCH may become more time-consuming and create further delays. Your cash flow may slow or stop and your credit worthiness may suffer.
Peer Feedback -- ICD-10 Transitioning
Since early 2013, we've been asking health care stakeholders like you about their ICD-10 readiness. For example:
Has your practice begun the transition to ICD-10?*
27% said YES 57% said NO or were UNSURE In February, 2013, we asked Medical Association of Georgia (MAG) members that same question: 18% responded YES, they had begun the transition.
If you haven't begun the transition to ICD-10, start now. Do not delay.
Who is the ICD-10 "Champion" in your organization?**
Billing managers were identified as "Champions" by 25% of those responding Practice managers came in a close second at about 16% Other "Champions" included physicians, other clinicians, coders and outside coding and billing firms
If you haven't appointed an ICD-10 Champion in your organization, it's not too late.
When do you anticipate starting your organization's formal training on ICD-10?**
13% of our respondents are already underway with their formal training Another 25% of our respondents will get going before the end of 2013 In total, about 38% responded their training will be underway by year end
ICD-10 will definitely require training. The code structure, degree of specificity and documentation required are drastically different from ICD-9.
Has your organization crosswalked your most frequently used ICD-9 codes to ICD-10? **
12% of those responding said YES The remaining 88% said NO, UNSURE or provided NO ANSWER
This is an early critical step in the transition from ICD-9 to ICD-10. You will definitely need to purchase a new ICD-10 code book. However, there are both free (the GEMs tool from CMS) and cost-based online translator tools available to help you get started with your crosswalking.
Get the 4-1-1 on ICD-10
A wealth of information is yours for the linking. Check out DCH's ICD-10 webinars (past events, viewable on demand; upcoming events are open for registration). View FAQs and other information. The Centers for Medicare & Medicaid Services (CMS) hosts an extensive library (including the free GEMs tool) for your use.
We welcome your questions and comments at icd10project@dch.ga.gov.
*DCH/ICD-10 webinar polling conducted in March, 2013. ** DCH/ICD-10 webinar polling conducted in June, July and August of 2013.

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.
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

Medicaid Enrollment Required for Ordering, Prescribing and Referring (OPR) Providers
Pharmacy Denials Begin on October 1, 2013
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 beginning later this year. Your individual (not organizational) 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.
Please take a few moments to ensure that your individual NPI is on file at DCH by logging onto the Georgia Medicaid Management Information System (GAMMIS) provider portal and reviewing your information.
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 the individual NPIs for OPR providers be included on all claims.
Pharmacy Claims -- Take Note! On August 1, 2013, DCH began editing 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.
Other Claims Editing Coming Soon! DCH will begin OPR editing for claims for all other categories of service at a later date.
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.
To Get Started on OPR Enrollment
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.
OPR providers are encouraged to enroll in Medicaid through the Georgia Medicaid Management Information System (GAMMIS) Web Portal.
OPR providers may submit a paper application instead of completing an online application. The paper application (with instructions) can also be found on the GAMMIS portal.
Additional information may be found in the Frequently Asked Questions (FAQ) document posted on the DCH website.
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.

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
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.

Early Elective Deliveries Policy Begins October 1, 2013
The Georgia Department of Community Health (DCH) will implement its new policy regarding non-payment of non-medically necessary early elective deliveries (prior to 39 weeks gestation age) for claims submitted with dates of service on or after October 1, 2013.
As of that date, professional 1500 claim forms will be denied if the appropriate modifier (UB, UC or UD) is not submitted with the billed delivery procedure code. Hospitals are encouraged to collaborate with their physicians privileged to provide obstetric services to develop guidelines and/or protocols and established documentation standards for deliveries prior to 39 weeks gestation. Hospitals and physicians submitting delivery claims must adhere to the new policy.
The Georgia Medicaid Management Information System (GAMMIS) is being configured to accommodate this policy change. Policy compliance will be monitored by DCH and the Centers for Medicare & Medicaid Services (CMS) through Georgia's Initial Core Set of Health Quality Measures for Medicaid Eligible Adults (Measure 14).
If you have questions about this policy, please contact Argartha Russell, director of Medical Policy, at 404-651-9606 or via e-mail at arussell@dch.ga.gov.

Personal Attention:
Georgia Medicaid Pediatric Practice Boot Camp
Do you want some one-on-one time for your practice staff with Medicaid and Hewlett-Packard experts? Then check out the Georgia Medicaid Pediatric Practice Boot Camps this fall. Attendance is open to practice managers, billers and coders, and claims staff.
The Georgia Department of Community Health (DCH) and the Georgia Chapter of the American Academy of Pediatrics (GAAAP) are hosting these free events across the state. Each half-day session will provide ample time for you and your staff to interface about specific issues and concerns.
So far, these dates and locations have been confirmed, but more events are being added during the next month or so.
Cordele State Office of Rural Health, Cordele, GA
Wednesday, September 18, 2013 (9 to noon or 1 to 4 p.m.)
Tucker HP Enterprise Services, Tucker, GA
Wednesday, October 2, 2013 (9 to noon or 1 to 4 p.m.)
Augusta Evans Government Center, Evans, GA
Wednesday, October 16, 2013 (9 to noon or 1 to 4 p.m.)
Medicaid Issues to be Addressed Include:
Claims -- Address specific claims issues and get answers to your claims questions. Provider Enrollment -- Learn about online provider enrollment, review your practice affiliations, and check the status of submitted applications. GeorgiaDirect -- Find out about the benefits of GeorgiaDirect, secured messaging offered by the Georgia Health Information Network (GaHIN) at no cost to providers and how it can help you reach Meaningful Use. Get assistance in registering for your GeorgiaDirect e-mail address. Medicaid Electronic Health Records (EHR) Incentive Program -- Determine if you are eligible to receive up to $63K per provider in your practice. You may also receive assistance with registration for the Medicaid EHR Incentive Payments, including a discussion about the patient volume calculator and documentation requirements. GA Health Information Technology Extension Center (GA-HITEC) -- Learn how to navigate registration for Medicare and Medicaid EHR Incentives Program Registration and Attestation and be guided to becoming Meaningful Users of certified EHR technology.
For complete details and to register, click here. Space is limited so register early.

Changes Coming to the 2014 State Health Benefit Plan
The State Health Benefit Plan (SHBP) serves as the state's administrator of health insurance coverage for more than 650,000 members. Blue Cross Blue Shield of Georgia Inc. (BCBSGA)
has been awarded the contract to provide health plan administration and medical management for the SHBP. BCBSGA will coordinate closely with Express Scripts Inc., selected to administer pharmacy benefits, and Healthways Inc., selected to administer wellness programs and related incentives. The BCBSGA award also includes fully insured Medicare Advantage (MA) and Prescription Drug Plan options for retirees with Medicare.
The new plan contracts will be effective for Plan Year 2014, which begins on January 1, 2014.
All SHBP members statewide will have access to a high-quality provider network and will have the choice of enrolling in one of three self-insured "metal" plan options (Bronze, Silver or Gold), which are subsidized for active employees and pre-65 retirees. Retirees must pay the full cost for these options, or may choose the subsidized Medicare Advantage options.
"The plan options for 2014 will provide members with the real possibility of financial relief and ensure that SHBP remains on a solid financial footing," said DCH Commissioner Clyde L. Reese III.
The Bronze, Silver and Gold options are Preferred Provider Organization (PPO) plans with a health reimbursement account (HRA). Members receive a starting balance in the HRA and can earn additional HRA credits by completing wellness activities during the year.
Retirees who are enrolled in Medicare may select from a fully insured MA PPO Standard option or a fully insured MA PPO Premium option. Both MA options are subsidized.
For this year's Open Enrollment and Retiree Option Change Period (October 21 through November 8, 2013), members are encouraged to use the new year round, 24/7 online enrollment and eligibility self-service web portal at www.myshbpga.adp.com.

More than $156 Million Paid in EHR Incentives
Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $156 million in payments of federal funds to eligible providers through August 19, 2013.

The program was launched on September 5, 2011.
Board Actions
The Board of Community Health took the following actions at its Thursday, August 8, meeting:
Public Notice GAPP Medically Fragile Daycare -- Final Public Notice -- Supplemental Inpatient-Outpatient Hospital Daycare -- Final Foster Care 1115 Public Notice -- Final Public Notice -- Outpatient Hospital Lab Payments -- Final Chapter 111-8-16 Disaster Preparedness -- Final Adoption Chapter 111-8-71 Traumatic Brain Injuries -- Final Adoption Chapter 111-8-54 Narcotic Treatment -- Final Adoption Chapter 111-8-19 Drug Abuse -- Final Adoption
Approved the 2014 State Health Benefit Plan (SHBP) Plan Designs and Rates SHBP Resolution August 8 Board Meeting 2014 SHBP Presentation
The Board of Community Health took the following action at its Thursday, August 22, meeting:
Approved the FY 2014 Amended Budget and the FY 2015 Budget Presentation Amended Budget and FY 15 Budget Presentation
The next meeting of the Board of Community Health will take place on Thursday, September 12, at 10:30 a.m. in the 5th Floor Board Room of 2 Peachtree Street, Atlanta.