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Kathy Whitmire HomeTown Health, LLC. From: Argartha Russell Sent: Monday, August 08, 2011 3:29 PM To: 'Kathy Whitmire' Cc: Edwinlyn Heyward Subject: Legacy.

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Presentation on theme: "Kathy Whitmire HomeTown Health, LLC. From: Argartha Russell Sent: Monday, August 08, 2011 3:29 PM To: 'Kathy Whitmire' Cc: Edwinlyn Heyward Subject: Legacy."— Presentation transcript:

1 Kathy Whitmire HomeTown Health, LLC

2 From: Argartha Russell Sent: Monday, August 08, :29 PM To: 'Kathy Whitmire' Cc: Edwinlyn Heyward Subject: Legacy Outlier Edit Kathy, Below is a banner notice that was posted today by HP on behalf of DCH. There have been concerns raised by hospitals that they still have not gotten paid for processed and paid inpatient claims that posted the ACS Outlier edit These paid claims were not sent to GMCF after the HP transition in November 2010, for the Outlier request. Please share this notice with your hospital members (to get this message out quickly) to send their old legacy inpatient claims to DCH. Thanks. Argartha Russell, Director GA Medicaid Division Medical Policy Unit (404)

3  If your UB-04 paid claims had not been processed by ACS as an outlier according to the procedures outlined in Appendix L of the Hospital Services Policy and Procedures Manual, please submit the following documents to the Department for review: ◦ A written letter requesting an outlier review with a list of each Transaction Control Number (TCN) that paid in the legacy system but had never received the outlier payment; ◦ A copy of the ACS’ Remittance Advice (RA) attached to your request that lists Edit 4807 for each TCN for outlier review; and ◦ Supporting documentation that demonstrates that you had requested an outlier review through ACS, e.g., correspondence tracking number, a cover letter addressed to Georgia Medical Care Foundation (GMCF).

4  Send your written request letter and the above supporting documents to the following address: Director Customer Service & Resolution Unit Department of Community Health Division of Medicaid 2 Peachtree Street, N.W., 37 th Floor Atlanta, GA  DO NOT SEND ANY MEDICAL DOCUMENTATION TO THE DEPARTMENT OR TO HP at this time for these legacy paid inpatient claims.  Upon receipt of the above documents a review will be conducted to determine if your request is valid. You will be notified in writing of the Department’s determination within 30 days.

5 CAH Specific Claims denying for 3 day window Error Code 5159

6 From: Edwinlyn Heyward Sent: Monday, September 12, :18 PM To: Kathy Whitmire Subject: 72 Hour Rule Policy Kathy, My staff and I figured out the issue relating to CAH’s being exempt from the 72º rule. Medicare requires all CAH to bill these claims on separate UBs. Section 906G in the hospital manual informs the provider to combine these charges; there are no exceptions to this policy. When these claims cross over, they are denying as possible dupe of a previously paid crossover claim. Possibly in ACS because of the way we were paying cross over claims at that time, there is a strong possibility that these claims paid. I’m not sure about that because I can’t find any old claims from ACS to validate this. We have opened an issue for this so that HP can do their research and my staff and I are pulling data to look at the budgetary impact if we allowed these claim when originally crossed over to pay. I hope this information sheds some light to the situation. Edwinlyn R. Heyward Director Customer Service & Resolution Department of Community Health Medicaid Division 2 Peachtree Street, N.W. 37th Floor Atlanta, Georgia (Telephone)

7  Edit 3044 and Provider Number does not match prior authorization  Physical Therapy Issue to move to production of final testing on Sept 15 th – Edit 3044 and 3003 modification and then they will apply to the universe.  Edit 3044 Mass Processing – Provider notice will be posted to inform providers about mass processing.

8 From: Kerry Elledge Sent: Wednesday, October 05, :24 AM To: Kathy Whitmire Cc: Blair Elledge; Jimmy Lewis Subject: RE: Quadax/HP meetinge I am going to be sending an update out to HTH re: Medicaid progress by end of week. We are moving along, and based upon our recommendations/discoveries/discussions, HP is working to reformat/map ANSI codes appropriately and pull across data in a meaningful way for posting capabilities. We have our third meeting with them next week and continue to test things with them on behalf of our clients!  Kerry Elledge  Executive, Account Management  Quadax, Inc.  ext (office)  (fax) 

9  Begins November 9 th with training and checklists to ensure that all hospitals are ready! ◦ Discuss Example of changes ALSO  12 month ICD-10 Readiness Program will be led by Sherry Milton, Coding & Documentation Expert will begin in January

10  Medicaid & CHIP Redesign  The Georgia Department of Community Health (DCH) issued a Request for Proposal for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids ® ).  The redesign initiative will focus on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations. On July 26, 2011, DCH awarded the consulting contract to Navigant Consulting, Inc.  SAVANNAH – Oct 12 th – First Meeting

11 NEWS:  New Members – Elbert Memorial & Chatuge Regional  New Partners – VendorMate and Data Rx – 340B for hospitals  New DCH Commissioner Davis Cook confirms keynote at Fall Conference EVENTS:  Oct 12 th – Medicare Monthly Webinar  Oct 12 th – Medicaid Redesign First Meeting – SAVANNAH  Oct 13 th – CNO – Case Mgr Workshop  Oct 18 th - Physicians’ Lunch and Learn – MU Series – Session 2  Oct 19 th – Interqual Cerme User Group Webinar  Nov 9 th, 30 th, Dec 7 th, 14 th – Countdown to HIPAA 5010  Nov 16 th -18 th – HTH Fall Conference  Dec 12 th -13 th – HIPAA Compliance Officer Training  Jan 19 th – 20 th – GA Rural HIT Conference - Macon

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13 ANNOUNCING HOMETOWN HEALTH 12 TH ANNUAL FALL CONFERENCE November – Callaway Gardens SPEAKERS AND SESSIONS INCLUDE: KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health DCH Medicaid – HP - CMO – Navigant Discussion PANEL: Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP Georgia Redistricting Update - David Tatum, CHOA A New Day in the Future of Health Care SPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente GA Health Information Exchange – GA-HITREC – Dr Denise Hines Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney Health Insurance Exchange – What Hospitals Need to do to Prepare - Ryan Teague 4 Requirements for Survival in 2012 and Beyond – PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn, Revenue Mgmt – Lynn Byrd


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