2015 Wyoming Medicaid Medical and Institutional

WorkshopsPresenters:

Amy Buxton – Provider Services ManagerSheree Nall – Provider Services Manager

Sara Rogers – Facilities ManagerBrenda Stout – Behavioral Health Manager

Session Topics:

• Introductions• Medicaid Decision Making• WY Medicaid ICD-10 Project• Upcoming Program Changes

–Chiropractic–Mental Health Provisional Providers

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Program Managers

• Amy Buxton – Ambulance, DME, Hearing and Audiology, Lab and Radiology, PT/OT/ST, Client Transportation

• Sheree Nall – Physician and Nurse Practitioner Services, Indian Health Services, ASC, Health Homes, Family Planning Waiver, Public Health Nurses

• Sara Rogers – Hospitals, ESRD, Nursing Home, RHC/FQHC, PRTF, CORF

• Brenda Stout – CMHC/SATC and Mental Health Services

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Medicaid Decision Making Process

• Code of Federal Regulations (CFR)– Title 42 – Public Health– http://www.ecfr.gov/cgi-bin/ECFR?page=browse

• Wyoming State Statutes– Title 42 – Welfare – Wyoming Medical Assistance and Services

Act– http://legisweb.state.wy.us/statutes/statutes.aspx

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• Wyoming State Rules– Agency: Health, Department of– Program: Medicaid– http://soswy.state.wy.us/rules/

• Wyoming Medicaid State Plan– Approved by Centers for Medicare/Medicaid Services (CMS)– http://legisweb.state.wy.us/statutes/statutes.aspx

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• Wyoming State Legislature– Statutes and Budget

• Governor• - Statutes and Budget

• Wyoming Medicaid, Division of Healthcare Financing– State Medicaid Agent– Provider Operations Administrator– Program Manager

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• ICD-10

– Coding Specificity– All required digits must be present– Review ICD-10-CM book for required digits– Claims will deny if codes are not complete– Unspecified codes will not be accepted

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Systems & Interface Testing

•Testing– Provider end-to-end testing is in progress – register at

www.wyomingicd10.com– Providers will be able to test specific clinical scenarios to

evaluate coder competency and/or evaluate claim processing and denial rates for batches of test files submitted

– MUST REGISTER TO TEST – all providers are encouraged to register for testing

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Why Test?

• Avoid payment and cash flow interruption• Ensure revenue neutrality – specifically hospital and inpatient level of care

payments• Ensure billing process readiness and system capability for interfacing and

transmitting ICD-10 claims to Wyoming Medicaid: YOUR BILLING SYSTEM MAY NEED UPGRADES OR ADDITIONAL CONFIGURATION EVEN IF YOUR BILLING STAFF IS PREPARED!

• At the conclusion of testing, providers will be provided with a summary of testing action, denial/paid rates, edits that posted and payment variances detected.

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WHY TEST?

Billing after 10/1/2015 will be date of service (DOS) driven:

•DOS prior to 10/1/2015 MUST be billed with an ICD-9 diagnosis/surgical procedure code.•DOS 10/1/2015 and after MUST be billed with an ICD-10 diagnosis/surgical procedure code.•Inpatient services that span September 2015 – October 2015 MUST have ICD-10 coding requirements, as the “through” DOS will determine coding requirements.

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New Programs and Program Changes

•Chiropractic•Mental Health Provisional Providers

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