HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 9:00 AM – 12:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Overview of Meetings • General Hospital Meeting 9:00-10:00 • Break 10 min. • General Hospital Meeting cont’d 10:10-12:00 • Lunch Break 12:00-1:00 • EAPG Engagement Meeting 1:00-3:00 • Specialty Hospital Meeting 3:00-4:00 2
HOSPITAL ENGAGEMENT MEETING TOPICS 5/4/2018 9am-12pm · General Hospital Meeting - Specialty Hospital Update - Items Pending Additional Research/Action - Medicare Crossover: 12X & Part A Exhausted prior to stay - Interim Billing Rules - TC/26 Modifiers - Baby on Mom's Claim Update - FY 2018-19 Hospital Base Rates Update - Mass Adjustment Updates (INPATIENT ONLY) - Inpatient Future Plans/Goals - Type of Bill 85X - Outpatient Future Plans/Goals - Staffing Updates 3 Colorado Department of Health Care Policy and Financing
GROUND RULES FOR WEBINAR WE WILL BE RECORDING THIS WEBINAR • ALL LINES ARE MUTED. PLEASE UTILIZE WEBINAR CHAT • WINDOW Please speak clearly when asking a question and give your • name and hospital If you wish to utilize the conference line for speaking, please • submit the request through webinar chat window. We will temporarily mute the microphones and activate the conference line. This may take a few moments. 4
Welcome & Introductions Thank you for participating today! • We are counting on your participation to • make these meetings successful 5
Dates for Future Hospital Engagement Meetings in 2018 1/12/2018 • The agenda for upcoming meetings will be available on our 3/2/2018 • external website in advance of each meeting. https://www.colorado.gov/pacifi 5/4/2018 • c/hcpf/hospital-engagement- meetings 7/13/2018 • Meetings will now begin at 9am 9/7/2018 • starting with 11/3/2017 meeting 11/2/2018 • 6
Audio The Department has been experimenting and researching other options for audio. Unfortunately, we have not found a way to include quality sound in the room while including the conference line. Additional request for equipment has been made but the conference line will continue to stay muted and on stand by while we utilize microphones in the room. If you would like to speak through the phone line, please submit the request in the chat box and we will take a moment to change over. We appreciate your patience and participation. 7
Agenda Items If you wish to request a topic for our next meeting. Please submit the request by the week prior to the meeting to ensure enough time is allowed to gather correct personnel and information on the topic. If a topic is submitted the week of the meeting, we cannot guarantee enough research will be completed to present at the meeting. However it will be carried over to the following meeting and any actionable items will be followed up with the Provider as soon as possible. Send all requests to Elizabeth Quaife at elizabeth.quaife@state.co.us The Meeting Agenda is posted on Monday the week of the meeting to our Hospital Engagement Meeting Website. 8
Proposed Meeting Changes Starting July 13 th we would like to align EAPG Meetings to the Hospital Engagement Meeting. This means EAPG meetings will be held from 11am-12:30pm every month. EAPGs will still continue on a monthly basis. Dates will remain unchanged. Proposed Schedule on Meeting Days Meeting Portion Time Hospital Engagement Meeting 9:00am-10:40am Break 10:40am EAPG Engagement Meeting 11:00am-12:30pm Provider Input: Is this agreeable or would we like to continue separate meetings? 9
Specialty Hospital Meetings Specialty Hospital Engagement Meetings 3/2/2018 1pm-2pm 4/6/2018 1pm-2pm 5/4/2018 3pm-4pm 6/1/2018 3pm-4pm Finalizing Budget Neutral Per Diem 10
Specialty Hospital Per Diem CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $2,188.44 35 $2,079.02 56 $1,975.07 >56 $1,876.31 REHAB 7 $962.63 14 $914.50 21 $868.77 >21 $825.33 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $2,172.96 35 $2,064.31 56 $1,961.09 >56 $1,863.04 REHAB 14 $944.23 21 $897.02 28 $852.17 >28 $809.56 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 Final Draft Options: Have already started obtaining preliminary approvals through the Department 11
Pending Additional Research and/or Actions The following items have been discussed at previous meetings and are pending while additional research and/or processes are being completed. An update is planned for July 13 th meeting. • Medicare Part A exhaust during stay • IPP-LARCs • Observations over 24 hours 12
Transportation (ambulance) Reminder please send inquiries or questions in regards to policy to the NEMT mailbox. Email Address: NEMT@hcpf.state.co.us 13
12X & Part A Exhaust Prior to Stay 14
Interim Billing Rules Type of Bill 112 • Reimbursed charges from Health First Colorado should be at a minimum of $100,000.00 (not billable charges) • Patient Status: 30, still a patient • Health First Colorado is primary payee. Medicare Crossovers and other 3 rd party payers do not qualify for interim billing **Rule language has been update for new Billing Manual Version 15
Interim Billing Rules (cont.) Type of Bill 113 • Additional $100,000 in reimbursed dollars from Health First Colorado (Total $200,000 minimum) • Patient Status: 30, still a patient • Health First Colorado is primary payee. Medicare Crossovers and other 3 rd party payers do not qualify for interim billing • Type of Bill 112 must be voided prior to Type of Bill 113 being submitted • Claim start date must be the admit date or reimbursement/APR-DRG may be impacted 16
Interim Billing Rules (cont.) Type of Bill 114 • Final Interim Bill after patient has been discharged • All previous interim bills must be voided prior to submitting final bill • Health First Colorado is primary payee. Medicare Crossovers and other 3 rd party payers do not qualify for interim billing • Claim must be billed for entire stay, from Admin date to Discharge date for accurate grouping and reimbursement 17
TC/26 Modifiers • TC and 26 modifiers must be appended to procedure codes that allow the modifiers if only one component of the service was performed. • Submitting a code that allows TC or 26 without a modifier signifies that the global service was performed by the submitting provider. • Only the global service or the TC/26 modifier combination will be paid, other combinations will be denied as duplicate services. • Procedure codes that allow TC and 26 can be found on the Department’s Fee Schedule. 18
TC/26 Modifiers • Claims missing the TC modifier must be rebilled in order for the professional claim with the 26 modifier to process correctly. • The Department will work with providers to address claims that hit timely filing after being rebilled for this reason. 19
Baby on Mom’s Claim - Update • The Department is identifying the institutional claims denying for age and/or gender edits and a transmittal has been sent to begin reprocessing these claims. A reprocess date has not yet been set for these claims. • The Department is reprocessing professional claims containing the UK modifier that denied for age and/or gender edits. The first wave of these claims processed in the 4/20/18 cycle. 20
Baby on Mom’s Claim - Reminder As previously discussed, if the baby stays after the mother is discharged, the baby will start their own claim based on the reason that they are staying past the mother's discharge. Using a newborn/live birth diagnosis code (Z38, Z38X or Z38XX) as primary diagnosis on the baby’s independent claim may cause the claim to be ungroupable and result in appropriate denial. If this happens, the hospital should focus admitting and primary diagnoses around the reason why the child is staying in the hospital and resubmit the claim. UB 04: IP and OP Billing Manual page 6 Additionally, for professional baby on mom claims the UK modifier needs to be present for the Department to identify the claim as a mom/baby claim. 21
Baby on Mom’s Claim Moving Forward Multiple groups within the Department are currently working on separating the baby from the mother’s claim. Currently working on: • System updates • Timeline for system implementation • Recalibration of weights • Rule & Policy changes The anticipated timeline and process will be communicated with Providers in future meetings. 22
Recommend
More recommend
