MEDICAID UPDATE FOR IOWABACK TO SCHOOL NURSE CONFERENCEJuly 23 2013

  • July 2013: Parent Consent changed to one time signature and annual delivery of Notification.

New Consent will be issued soon and be part of web IEP.

Notification will be issued soon and part of Procedural Safeguards issued annually.

  • July 2013: Medicaid FAQs revised.
  • July 2013: Revised T1001 RN code, now encounter, not 15” unit, max of 1 encounter per date
  • Aug –Nov2013: Trainings by webinar. First is Aug 15 9-10. See below
  • Oct 2013: Federal share changes on October 1, 2013: Drops from 59.59% to 57.93%.

For 100 dollars you are paid, you‘ll keep $1.66 less; per $100,000 keep $1660 less.

  • Future: LEA Medicaid Provider Manual: Update in process but release date not known
  • Oct 2014: Medicaid claims will require ICD-10 diagnoses

Training 2013-2014

The first 2013-14 Training session is scheduled for Thursday, August 15 9:00 a.m. to 10:00 a.m. You do not need to register. To join the meeting, go to:

Similar Medicaid trainings will be held in September, October and November. When scheduled, they will beannounced on the School Nurse list serve. All sessions will be recorded and can be later watched from a desktop. These will cover updates as well as a general overview of the program. Questions can be submitted before or during the sessionand will be answered in or after the session.

ICD-10

In 2012 it was announced that payments beginning October 1 2014 Medicaid would only pay claims if diagnosis was in ICD-10 CM format. That doesn’t mean dates of service on or after October 1 2014 but claims submitted on or after October 1 2014. Please begin this year to seek those ICD-10 codes from the student’s physician/ ARNP/PA/ other providers. In 2012-13 Iowa Medicaid paid LEA program claims on 5782 unique Medicaid members, for 527 ICD-9 diagnoses, 80 of which made up 90% of the total LEA revenue. For those 80,DE proposed cross walk numbersand submitted that crosswalk to Iowa Medicaid’s ICD-10 team. That team is reviewing and correcting that crosswalk.

Audits

  • Program Integrity (Iowa Medicaid Enterprise IME) RNs:
  • No reports issued in 2013: Reports of one LEA and one AEA are pending.
  • No news of additional LEAs selected.
  • Payment Error Rate Measurement
  • Not until 2014-15 school year

Exclusions

  • Reminder in April 2013 Provider Bulletin 1235 from Iowa Medicaid
  • April 2013 Guidance from Centers for Medicare and Medicaid (first main update since 1999)
  • Donoghue will demonstrate the Exclusions website today to anyone interested

Revenue

  • 2012-2013 LEA revenue of 81,686,569. After paying state share, LEAs retained 49.4 million.
  • 2011-12 LEA revenue of $71.9 million. After paying state share, LEAs retained $43.9 million.

Medical Billing Remittance from Iowa Medicaid Portal

  • Many business managers report not receiving invoices in mail so please help :Bulletin 1137

Jim Donoghue, Iowa DE. Phone 515-281-8505 Fax: 515-242-5988.