Tag: #Medicaid

Posted in #unitedhealthcare, Payers and CPT reinbursement, Training, Updates

Michigan Medicaid: reimburses for Doula Services-01/01/23

Posted on by KR2Medical Billing

The new coverage policy applies to Medicaid, Healthy Michigan Plan, MI Health Link, MIChild, Maternity
Outpatient Medical Services Programs.

Effective 01/01/23 – Michigan Medicaid members that belong to the above mentioned programs will be able to receive services from a certified doula during the the prenatal, labor and delivery, and postpartum
periods.

Doula- non clinical professional that provides physical, emotional, and educational support services to pregnant individuals.

In order for the Doula Services to be covered they need to be recommended by a licensed healthcare
provider.

Some of the Doula Services may include: (partial list) complete list is available click here.

Prenatal services, which include:
o Promoting health literacy and knowledge;
o Assisting with the development of a birth plan;
o Supporting personal and cultural preferences around childbirth;

Labor and delivery services, which include:
o Providing continual physical comfort measures, information, and emotional support;
o Advocating for beneficiary needs; and

Postpartum services, which include:
o Educating regarding newborn care, nutrition, and safety;
o Supporting breastfeeding;
o Providing emotional support and encouraging self-care measures;

Doula services are expected to be covered for face-to-face visits with the patient. Although the prenatal and Postpartum services may be done vial telemedicine, please MDHHS telemedicine policy.

Frequency: up to 6 visits are allowed plus 1 extra visit during the delivery. The duration of each visit needs to be at least 20 minutes. If the patient requires over the max allowed number of visits, then the provider may request more via PA process.

Documentation requirements: doulas need to document the start and end time of the visit for each patient. The documentation should include a description of the professional services rendered and information regarding the source of the licensed healthcare provider recommendation for services.

Reimbursement: in order to receive reimbursement doulas need to be a registered Michigan Medicaid Provider. Reimbursement amounts as follows:

Prenatal visit: S9445 Modifier- HD ICD-10 codes- Prenatal: Z33.1Postpartum: Z39.2 6 total visits Fee-$75 per visit

Attendance at Labor and Delivery: CPT code- T1033 Modifier- HD ICD-10 Code- Z33.1 Max 1 visit Fee- $700

For complete information regarding coverage/reimbursement/provider enrollment, please visit Michigan Medicaid Site click here.

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Posted in MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Prior Authorization Insurance Carrier Updates, Training, Updates

MVP NY Medicaid Patients: coverage for Farxiga tablets

Posted on by KR2Medical Billing

If you are a physician prescribing Farxiga for any of your patients that have NY MVP Medicaid Coverage, this blog post is for you!

Farxiga may be considered for coverage when used for one of the applicable FDA-approved indications including:

  1. For the reduction of heart failure hospitalizations in adults with Type 2 diabetes mellitus and
    established cardiovascular (CV) disease or multiple CV risk factors
  2. For the treatment of heart failure with reduced ejection fraction (NYHA classes II to IV) to
    reduce the risk of cardiovascular death and hospitalization for heart failure
  3. For the treatment of chronic kidney disease to reduce the risk of sustained eGFR decline, endstage kidney disease, cardiovascular death, and hospitalization for heart failure in those at-risk
    of disease progression

There are 2 other medications that are on the MVP Formulary that do not require prior authorization (such as Segluromet and Steglatro).

If the patient requires Farxiga then the physician needs to obtain a prior authorization.

Please follow the steps: (ALL requests have to have documentation submitted to support the use of Farxiga)

A. Visit mvphealthcare.com/Providers and Sign In to your Provider online account to use the new electronic prior authorization tool powered by Novologix®.
B. Complete the appropriate MVP prior authorization form, which can be accessed at
mvphealthcare.com/Providers, then select Forms, then under Prior Authorization, select the appropriate form in the Pharmacy section. Then, fax completed request form to MVP at 1-800-376-6373.
C. Submit a request through Surescripts.com or CoverMyMeds.com. ( covermymeds is also available on NAVINET)

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#farxiga, #mvpmedicaidplans, #priorauthorization, #MVP, #type2diabetes

Posted in BCBS (Various States), Training, Updates

BCBS Nevada Medicaid Plans: Palliative Care New Partner

Posted on by KR2Medical Billing

Effective 03/01/2021- Aspire Health, an independent company, will start to provide telephonic palliative care services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions, for BCBS Nevada Medicaid Patients.

What is Aspire Health?

Aspire offers a solution to the fragmented and expensive care that patients so often experience during the last chapter of life. Aspire helps patients to increase their overall comfort, increase their satisfaction with both their PCP and their health plan, minimize the risk of unnecessary or unwanted hospitalizations, and help ensure patients receive care aligned with their goals and values.

What does Aspire Health offer?

Aspire offers palliative services through two modalities, dependent upon the county where the patient resides:

  1. Nurse Practitioner-led, home-based program
  2. Palliative Social Worker-led telephonic program.

Both programs include wraparound support from a specialized interdisciplinary team with 24/7 on-call support and the oversight of Aspire’s lead physicians to enhance care to patients and families, personalize their experience, and facilitate timely intervention.

Through patient and caregiver education and expert symptom management, Aspire’s intervention is designed to align medical care with each patient’s goals and minimize unnecessary emergency department visits and hospitalizations, thus impacting care quality and driving value to patients, families, and referring physicians.

What type of patient would need services that Aspire health offers?

Patients that would require services from Aspire Health is typically the sickest. The patients may confront multiple illnesses, such as chronic heart failure, chronic obstructive pulmonary disease, advanced cancers, dementia, geriatric frailty, chronic or end-stage renal disease, chronic liver disease, cerebrovascular accidents, and other neurologic illnesses. These patients also have high utilization costs and may see multiple providers or frequently seek uncoordinated care in emergency rooms and hospitals.

The patients may have limited family support or family caregivers with their own health concerns. The confluence of these factors often results in frequent hospitalizations for uncontrolled symptoms and/or exacerbations of chronic disease.

What if I need more information?

More information is available at aspirehealthcare.com or by calling the 24/7 Patient and Referral Hotline at 1-844-232-0500.

#palliativecare, #bcbsnv, #medicaid, #aspirehealth

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