Reimbursement Committee Minutes
March 20, 2013
Mission: The Michigan Home Health Association is the unified voice, principal resource and advocate for the success of its member organizations as best practice providers of home health, private duty, home medical equipment and pharmacy-infusion services for the residents of Michigan.
Minutes
I. Call to Order
a. Introductions
b. Acceptance of Minutes .
c. Agenda Additions:
Go over, “To Do Items” from previous meeting
i. Amy to contact Sheryl Passinault at Humana and then contact Barry to issue letter (Forward).
ii. Abby to send link regarding eligibility checking for Medicare to Mary (Barry to have Mary check with Abby).
iii. Chris to ask Abby about Benchmark’s Net Margin for Clarity (Forward).
iv. Fred to send Amy and Chris MSP Consultant Information. (Done).
II. Reports:
a. Executive Director Report – Barry Cargill
i. Sequestration 2% beginning April 1, 2013.
ii. MHHA announced its possible name change to committees. MAHC – Michigan Association for Home Care. This change is being made to better represent and be inclusive of all aspects of home care.
iii. Barry spoke of BCBS Exchange possibilities and its affects. The State is deferring to the Federal Exchange.
iv. Upcoming Events:
State Legislative Conference – May 8th
Annual Conference – May 22-24th
b. BCBS Liaison Meeting – Issue forms available – Submit to Pfeiffer.mary@MHHA.org Meeting January 24th.
Possible increase to Start of Care reimbursement. Possibly to combine RV with Assessment codes. Looking at January, 2014.
Not interested in any other rate changes.
Moratorium will not be lifted.
No plans for Telehealth reimbursement
c. Medicaid Liaison Meeting – Mike Hall – Nothing
d. Biller’s Committee – Dawn Hyder, Chair and Amy Gil, Co-Chair – Next meeting April 25th
e. NGS/CMS – Chris Kisell –
i. MSP – Non-trauma Diagnosis claims
MLN SE 1305 – Full Implementation Phase 2 May 1, 2013
Ordering Physician Edits
ii. Jurisdiction 6 Protest dismissed – NGS remains to continue to process.
III. Old Business
1. Reimbursement Listserv is up and running per Kim suggestion. Contact Cindy to get put on the list.
2. Call With Experts – Group has no information on call today.
IV. New Business
1. Sequestration of 2% is beginning on April 1. It effects patients with a discharge of April 1st and later. Remittance Advices will look different.
2. Medicare Remittance Advices are not reconciling. The patient detail differs from the net payment. The detail reflects another payment of a RAP instead of appropriate take back. However, the net reimbursement is correct. This has been since rectified.
3. Accountable Care Act – Insurance requirements. Discussed what agencies were thinking about doing with regard to FTE’s. Covering employees with insurance will be very costly and could be a very large hardship.
4. Benchmark for 1st quarter is due the first week of May.
V. General Business
A. Payer Line
Medicare- Nothing
Medicare Advantage Plans – Prefix changes can create billing issues. Claim with dates previous to new numbers should keep old prefix until the following claim.
Medicaid- There was mention of a possible waiver rate change.
BCBSM- Therapy denials; non-therapy diagnosis. V5482 Explanation of Joint Prothesis
Other Payers – Nothing
B. Product Line
Certified- Nothing
Hospice- Nothing
HME- Nothing
Private Duty- Nothing
VI. To Do Items
1. Barry to send letter to Sheryl Passinaultl from Humana.
2. Chris to ask Abby about Benchmark’s Net Margin Line for clarity.
3. Mary to check with Abby regarding link for eligibility checking.
VII. Next Meeting is on April 17th, 2013 (Teleconference).
VIII. Attendees at the March Meeting
Chair: Chris Kisell
Present: Fred Lee, Laurie Mones, Penny Rhien, Amy Gil, Mike Hall, Kim Jenks, Kerri Allen