The Georgia Psychological Association has received communications regarding the NCCI/MUE Adjustment for Physicians, DME, Health Check, and Other Provider Types. This webpage will provide 1) updates on GPA's activity in regard to this issue and 2) resources that may assist psychologists in individually handling the issue.
GPA Activities Regarding the NCCI/MUE Adjustment:
- January 20, 2016: Executive Director Martha Turner-Quest receives a call about a Medicaid coding issue from GPA Member Dr. Brendan Engen. Mrs. Turner-Quest notifies GPA's Insurance and Managed Care Committee Chair Dr. Frank Harbin in regard to Dr. Engen's call.
- January 21, 2016: GPA Member Steven Perlow asks the Committee on Independent Practice (CIP) Listserv if anyone else has received requests from Medicaid requesting significant sums of money to be returned to them by multiple providers for services provided in 2013 and 2014. On the same day, Martha Turner-Quest receives a call from a billing professional that works for several psychologists in the state of Georgia. The billing professional alerts GPA in regard to a 1/20/16 remit from Medicaid which reflects the reprocessing of claims all the way back to 2013. Martha-Turner Quest updates Dr. Frank Harbin on the call.
- January 22, 2016: Dr. Frank Harbin notifies the CIP listserv of the billing professional's call. Dr. Harbin says he will investigate the issue and if there is possibility for redress. He also states that he will attempt to get clarification from the Department of Community Health (DCH). Dr. Harbin says that it seems to be a Federal initiative, and the Georgia Insurance Commissioner will have no power over this process. He lets CIP listserv members know, after reading the January 4, 2016 provider message posted on the Georgia DCH Provider Message Webpage, that psychologists can adjust or resubmit correct claims between January 29 and February 29, 2016. This same provider message states that "providers will be able to view their impacted claims on the MMIS Web Portal (www.mmis.georgia.gov)."
- January 25, 2016: The Georgia DCH posts another message to providers titled "NCCI/MUE Adjustment for Physicians, DME, Health Check, and Other Providers."
- January 26, 2016: Discussions have continued on the CIP listserv. Dr. Frank Harbin indicates that he has reached out to the American Psychological Association and is waiting to hear back. GPA President Dr. Gayle Spears and Dr. Frank Harbin discuss the situation.
- January 27, 2016: Dr. Gayle Spears, GPA's Legislative Committee Chair Dr. Daniel Rogers, and Martha Turner-Quest hold a conference call. Dr. Spears updates Dr. Frank Harbin on the discussion of the conference call.
- January 28, 2016: Dr. Frank Harbin sends the CIP listserv a template letter to send to both federal and state congressmen/women regarding the Medicaid issue. Dr. Harbin indicates that he has made contact with the American Psychological Association (APA), and they would get back to him in the next week. He also states that he has reached out to the Georgia DCD.
- February 3, 2016:
- Dr. Frank Harbin informs the CIP listserv that there are ongoing discussions on this issue at the Georgia capitol but he did not have any updates at this time. Dr. Harbin reminds members that the Georgia DCH is aware of the possibility that they will lose qualified providers because of this and wants to prevent that, if possible. He requests that members send more letters and emails to state and federal legislators.
- Dr. Frank Harbin talks with Dr. Gayle Spears before and after Dr. Harbin's scheduled call with the APA Practice Organization.
- Later in the day, Dr. Harbin updates CIP listserv members on his conversation with Stacey Larson at the APA Practice Organization. Stacey Larson and her staff had done a fair amount of research on the coding issues involved. Stacey does indicate that this is not a national issue, but seems to only be occurring in Georgia.
- Martha Turner-Quest sends out a short survey to GPA members and non-members in regard to this issue in order to assist GPA in understanding the extent of the issue and help inform future steps.
- February 4, 2016: GPA receives 112 responses to the short survey sent the prior day. Twenty-nine respondents state that they did receive a notification from Medicaid requesting reimbursement for codes which were supposedly improperly billed between 2013 and 2015; 82 respondents stated they did not. Martha Turner-Quest reaches out to GPA Attorney Rob Remar.
- February 5, 2016:
- Dr. Frank Harbin updates the CIP listserv that he, and others, have had ongoing discussions with GPA's and the APA Practice Organization's legislative delegation as well as leadership at the DCH about how to resolve the issues. He indicates that the DCH has been both receptive and willing to attempt to find a resolution. He says that DCH is actively pursuing the possibility of opening up other codes. It is suggested that no one rebill anything until next week. DCH does indicate that February 29 is a hard date imposed by the federal government, and there will not be an extension beyond that date. Dr. Harbin also updates listserv members that GPA has received explicit advice from APA to not hire an attorney to represent those affected by this.
- GPA is still waiting to hear from Attorney Rob Remar for a second opinion. Martha Turner-Quest has also consulted with the GPA accountant.
- GPA is waiting on a contact email at DCH to help those psychologists affected.
- February 8, 2016:
- GPA receives a contact email from the Georgia DCH to help communications between HP and psychologists. Hewlett Packard Enterprise- Provider Relations Team - firstname.lastname@example.org / HP has stated that they have two senior staff monitoring this email.
- Martha Turner-Quest receives communication from Attorney Rob Remar recommending against hiring legal representation for this particular issue.
- February 10, 2016: GPA adds a form to the 2016 Medicaid Updates webpage to capture information from those who are affected by the NCCI/MUE Adjustment.
- February 11, 2016: Linda Wiant from the Georgia DCH confirmed that DCH will be reprocessing all of the claims on their end. The funds will be available around 2/22 (normal payment cycle) and their intent is to restore all of the paid claims. This means that those affected do not need to do anything at this point. They will be posting a banner message to this effect soon.
- February 12, 2016: A banner message titled "NCCI/MUE Mass Adjustment for Psychology Providers COS (570)" was posted on the Georgia DCH webpage. Please refer to the message at the link for their resolutions so far. In summary, HPE will automatically reprocess any Psychology Services (Category of Service 570) claims adjusted since January 29, 2016 that denied for MUE upon resubmission. This reprocessing will be performed for the February 22, 2016 financial cycle. This auto-resubmission process will restore providers’ psychology claims as originally paid.
- February 24, 2016: Message from DCH:
Thanks to quick reporting from members of the Georgia Psychological Association, the Department of Community Health identified issues with the reprocessing of claims associated with NCCI adjustment that occurred this past weekend. One of the primary issues affected the reprocessing of claims with dates of service 8/1/2013 and after and only allowed 1 unit for procedure code 90832. This communication is to advise Medicaid Psychology Services providers that HPE is currently making system configurations to reprocess claims that paid 1 unit of 90832 for dates of service on or after 8/1/2013 (these claims appeared on RA 2/22/2016). HPE will reprocess the associated claims again in this week’s pay cycle (RA 2/29/2016). Through this reprocessing, DCH is planning to restore claims to their paid status as they were before the NCCI adjustment. Therefore, if a paid claim had successfully billed for 2 units in 2013, when reprocessed again on the 2/29/2016 RA, both units should be credited back to the provider’s account.
Therefore, no action is required on the provider’s behalf to correct the claims that may have only paid 1 unit in the 2/22/2016 reprocessing. Please do not adjust claims to change the originally billed 90832 to 90837.
After this reprocessing on 2/29/2016, if any further adjustments are required to append claims with modifiers to comply with NCCI/correct coding, these adjustment will need to be completed by Noon on Friday, March 4.
HPE Call Center Leaders and field representatives have been notified of this. If you have any questions, you may contact your HPE Provider Relations representative or Nancy Moore, Psychology Services Program Specialist at email@example.com or 404-657-7884.
- February 25, 2016: DCH hosts a webinar and invites GPA members to attend.
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