Recently, I attended a webinar that was hosted by the NY DOH, regarding the updates for the NY Medicaid EHR Incentive program or as of April 2018 (CMS Interoperability Program) for the year 2018.
I learned about the changes that were done to the MEIPASS, online attestation system, as well as where to find out the latest training webinars (previously recorded), or who to contact if you need to speak to someone.
However, the most interesting thing that I learned was regarding the attestation for the New Physicians, that joined any NY Practice in the beginning of 2018.
The question was: “We have a few new physicians that joined our practice back in the beginning of this year (2018). Can we use them in the attestation for this year?”
The answer to the questions is “depends”:
a. If the New Physician participated in the program in another state, BEFORE year 2017 (attestation year 2016) and has joined your practice in this year, then YES
b. If the New Physician DID NOT participate in program in another state then the answer is NO
The attestation in MEIPASS will open on 07/01/2019 and End on 09/30/2019.
The following is the list of all the EmblemHealh Plans for 2019 that do not require a referral from their primary to see a specialist.
Access I/II, EmblemHealth Platinum Choice, EmblemHealth Gold Choice, EmblemHealth Silver Choice, EmblemHelath Gold Premier 1, EmblemHealth Silver Plus1, EmblemHealth Silver Premier, EmblemHealth Platinum Premier, EmblemHealth Gold Premier, EmblemHealth EPO Value, EmblemHealth EPO Value HDHP
Medicare Advantage Plans:
EmblemHealth VIP Go (HMO-POS) plans, EmblemHealth Affinity Medicare Passport Essentials (HMO), EmblemHealth Affinitiy Medicare Passport Essentials NYC (HMO), EmblemHealth Affinity Medicare Utimate (HMO SNP), and EmblemHealth Affinity Medicare Solutions (HMO SNP)
Remember if the EmblemHealth HIP plan has a Montefiore Logo and you are going to the provider associated with Montefiore you still also DO NOT Require a referral to see that specialist.
With the number of Urgent Care Centers on the rise since 2015, there were new codes added just to represent where the patient went. However, not all payers had a clear payment policy for those codes. When I used to work for the Urgent Care back in 2015-2016, this was a major billing issue I had to personally deal with.
Here is the most updated Payment policy for Urgent Care codes: S9088 and S9083:
Definition: S9088- the services provided in an urgent carte center
Definition: S9083- global fee urgent care centers
*CMS considers both of these codes as informational codes so there is no reimbursement for them.
According to MVP Health Care effective 12/01/2018 they will adopt reimbursement payment policy “based on the E/M code billed for the services”.
***Providers should bill an appropriate E/M code with a Place of service 20 (URGENT CARE)*** Unless the Urgent care is part of a hospital where the POS (place of service can be 22, outpatient hospital). Article 28 is not recognized by some payers, therefore to avoid unnecessary denials the providers should still bill POS 20.***