Help MSMA Fight Anthem's New Emergency Services Policy
MSMA has joined forces with the Missouri Hospital Association, the Missouri Association of Osteopathic Physicians and Surgeons, and the Missouri College of Emergency Physicians to fight a new cost-shifting scheme by Anthem Blue Cross Blue Shield to deny coverage for emergency services when it decides after the fact that the services were not for a true emergency. Seeing the new policy as dangerous for patients and an unacceptable violation of state and federal patient protection laws, the coalition is working for a remedy.
An important part of the coalition’s strategy is to generate data and real-life examples of the negative impact the Anthem policy has on health care providers and patients. A website is now open to allow providers and patients to confidentially tell their stories.
If you have been impacted by the new Anthem policy, or know someone who has, please help the cause by putting the website to good use. Tell Your Story Here!
Medicaid Managed Care Provider Enrollment is Coming
Beginning January 1, 2018, federal regulations require all states to screen and enroll, and periodically revalidate, all network providers of Medicaid managed care organizations. This requirement applies to all ordering, prescribing, and referring providers in the managed care setting, as well. It does not cause managed care network providers to see Fee For Service Medicaid clients.
Missouri Medicaid Audit and Compliance is working with MO HealthNet (Medicaid) and the managed care health plans to provide a streamlined process for enrolling managed care network providers that have not yet enrolled with MO HealthNet. Questions can be directed to MMAC.ProviderEnrollment@dss.mo.gov.
Missouri Medicaid Announces Rate Reduction
MO HealthNet has issued a Physician Program Rate Update Bulletin announcing a 3% rate reduction effective July 1 due to reductions in the state budget. Other Medicaid services receiving the 3% reduction include rehabilitation, dental, DME, audiology, hearing aids, ambulance, behavioral, and optical services. To monitor future announcements, watch MO HealthNet’s website.
Fees for Medical Records Effective 2/1/17
The new maximum fees for copying medical records will be $24.85 plus $0.57 per page for the cost of labor and supplies for copies provided in paper form, and $23.26 for additional costs if records are maintained off-site. The new maximum fees for copies provided electronically will be $24.85 plus $0.57 per page, or $108.88 total, whichever is less. For more information, go to: http://health.mo.gov/atoz/fees.php.
HIPAA and Fees for Medical Records
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a covered entity may only charge an individual or the individual’s personal representative a reasonable cost-based fee. The Office for Civil Rights has posted guidance regarding what a covered entity provider may charge an individual or the individual’s personal representative here.
Medicare Fraud Alert
If you receive a request for a signature on a Certificate of Medical Necessity for a patient not known to you, the physician area already completed, or if you receive a request for medical record documentation for a patient where you did not order the DME item, or that you do not believe is appropriate for the patient, please treat this as a fraud issue.
You can submit the information to OIG Hotline: 800-HHS-TIPS (1-800-447-8477) or online at https://forms.oig.hhs.gov/hotlineoperations/