Category: NY Providers

Find Medical Billing and Coding guidance for any Providers that operate in NY State

Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY Medicaid Plans: Medical Devices and Supplies coverage change

Posted on by KR2Medical Billing

This policy applies to MVP NY Medicaid Plans and their coverage for Medical Devices and Supplies.

The following examples are not all inclusive, that apply to this policy:

  1. Foot Care products: insoles, massagers, arch supports
  2. Pill Splitters
  3. Body weight scales
  4. Pulse Oximeters
  5. Thermometer’s (only oral, rectal and basal are covered)
  6. Wheelchair products
  7. Medical fridges
  8. Commodes
  9. Transfer benches
  10. Safety rails (bed, wall, bath)
  11. Fetal dopplers
  12. Bath/shower/toilet sears
  13. Sharp’s containers
  14. Ear Plugs
  15. Nasal dilator strips
  16. Cushions
  17. Decompression belts
  18. Reaches
  19. Travel Coolers etc
Picture Via Cumberland ME

MVP is aligning with NY Medicaid Fee for Services DME coverage. Devices or supplies that are NOT COVERED under FFS Medicaid “Pharmacy Fee Schedule” will continue to not be covered. Applicable DME Products should be billed under the member’s DME Benefit.

For complete list of NY MEDICAID DME COVERED and NON-COVERED Products, please click here.

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Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP (NY): ABA Services Coverage update DOS 10/01/21 and thereafter

Posted on by KR2Medical Billing

This blog post applies to physicians that are providing ABA ( Applied Behavior Analysis) services to MVP Managed Medicaid Patients.

Earlier this year MVP sent a notice to patients and Physicians that ABA (Applied Behavior Analysis) services will be covered for patients under 21 years old that have the MVP Managed Medicaid Plan, effective 10/01/2021

However, NY DOH (NY Department of Health) changed that for DOS 10/01/2021 and thereafter.

As of now ABA services are NOT COVERED FOR MVP Managed Medicaid Plans (for patients 21 years old and younger).

NY DOH will continue to cover the ABA Services for only Medicaid fee-for-service members, 21 years old and younger.

MVP is monitoring NY DOH and will make timely updates available as applicable.

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Posted in NY Providers, Training, Updates

NY Providers: What does “Medicaid ATB Reduction Applied” adjustment means?

Posted on by KR2Medical Billing

I recently was contacted by an independent physician (POS 11), regarding an adjustment that states “Medicaid ATB Reduction Applied”. This was on his claims for the Managed Medicaid Plans. Please see below.

Managed Medicaid Plan EOB example

Back in early 2020, I warned NY providers that there will be NY State Medicaid reductions (due to COVID-19 Pandemic). My clients already knew to expect it. However, since this particular independent physician had an out-of-state billing services, he was not notified.

So, what does this mean?

ABT stands for across the board. So, the “Medicaid ATB Reduction Applied” means just that- the reduction in payment was applied.

Now it is helpful to mention that this particular independent physician does have an office and a fee for service contract with Managed Medicaid Plans. Not all services are subject to Medicaid ABT Reduction.

Please see below for the partial list of services that are exempt from this reduction:

Some of the services that are subject to this reductions are: (partial list)

NY Managed Care Plans and this includes HIV SNP plans)

Please note that initially NY Medicaid did institute a 1% reduction, effective DOS 01/01/2020 and beyond. However, as of 04/01/2020 that amount is now 1.5%. .

For more information about this and the complete lists of exempt/affected services, please click here to visit the NY Medicaid Website.