Current Claim Jumper
May 2012
Claim Jumper
Previous
Claim Jumper Issues
Spring Provider Fair
2012
Provider Fair 2012 is scheduled for May 15–16, 2012, at the
Great Northern Hotel in Helena. The full
Provider Fair agenda and course descriptions are available.
Register for Montana Health Care Programs Provider Fair
courses at the link below. We recommend that participants register
individually.
Provider Fair Registration
In conjunction with the Provider Fair, the Montana Medical Association/Brown Consulting Associates are offering a coding workshop at the Great Northern Hotel on May 15 from 8:30–11:30 a.m.
| DAY 1 |
Eligibility The New Biller course focuses on the basic steps needed to begin billing, and includes verifying eligibility, completing claim forms, submitting adjustments and attachments, and reading the remittance advice. This course is geared toward new first-time billers. Billing Basics takes a more in-depth look at using resources on the Montana Health Care Programs website and navigating the Montana Access to Health (MATH) web portal. During the course, we will discuss claim denials, use the resources available to interpret the reason and remark codes, and solve the mystery of why a claim denied. This course also includes electronic claims information with a focus on 5010 changes and CyberAccess. SURSThe Surveillance and Utilization Review (SURS) Unit protects the integrity of Montana Medicaid from fraud and abuse. SURS reviews paid claims for Medicaid services to verify compliance with program policies as well as State and Federal Laws. Covers audit types and how they progress.
|
| DAY 2 |
Hospitals, FQHCs, and RHCs The FQHC, dialysis, and ASC presentation provides an overview of recent CMS changes, the effects these changes have on programs, and other updates as requested. Additional presentations include a Present on Admission (POA) update regarding Department system changes, prior authorization requirements for services and contact information, and how to bill correctly for claims where the client has partial eligibility. Healthy Montana Kids (HMK)This course provides a brief introductory overview of Healthy Montana Kids, including definition of populations served, claims submission requirements, and benefit variation between HMK and HMK Plus. Includes detailed discussion of Prospective Payment System for FQHCs and RHCs and explanation of Presumptive Eligibility (now offered to uninsured children statewide through participating facilities). Indian Health Service (IHS)This course for Tribal and IHS Medicaid providers includes:
The Medicaid Nursing Facility Services Program pays for short-term and long-term nursing care for individuals eligible for Medicaid. Participants discuss prior authorizations, nursing facility claim reviews, facility reporting requirements (i.e., Monthly Nursing Home Staffing Report, Hospital Holds, THV Requests, and Nurse Aide Testing and Training). Physician-Related ServicesA general overview intended for new billers. The last 15 minutes of the presentation includes recent updates to the Physician Program. School-Based Services The services include Therapies, Private Duty Nursing, Personal Care, and Transportation for children on Individual Education Plans or IEPs that are in Special Education. Includes discussion on coding tips and claim submission as well as finding client eligibility. Other topics of discussion include Child Profile forms, Task Hour Guides for Personal Care, and the recently changed Medicaid Administrative Claiming (MAC) program, and includes a discussion of those changes and details on problems that continue to occur. Home- and Community-Based
Services Electronic Health Records
(EHR) Adult Mental Health Dental Transportation Children's Mental Health The presentation provides an overview of all mental health programs administered through the Children's Mental Health Bureau (CMHB) which is mostly funded by Medicaid. In addition, the presentation provides an overview of recent changes in the CMHB system and progress towards CMHB’s vision to build an integrated system of care for programs serving Montana families, youth, and children. Medicare/TPLThis course gives a broad overview of how Medicare and TPL work in the Montana Health Care Programs claim processing system, and how each is applied. The course covers crossovers, coverage, eligibility, claim form completion, and paperwork attachments. SURSThe Surveillance and Utilization Review (SURS) Unit protects the integrity of Montana Medicaid from fraud and abuse. SURS reviews paid claims for Medicaid services to verify compliance with program policies as well as State and Federal Laws. Covers audit types and how they progress. Managed Care |