You are here: Home / Archives for DMA

Home Health Care Agency Guide to Getting Paid During Appeals

December 27, 2010 By

Your Home Health Care Agency won’t stay in business if you can’t get paid!  DMA’s site has a new “how to get paid” guide, located at http://www.ncdhhs.gov/dma/provider/URVendorInstruct.pdf .  This guide makes a few points that are worth going over:

First, it is imperative to get your clients ready for letters from DMA or CCME which cut their hours.  They should know that they will have only ten days to get their appeal filed, and that your home health care agency will help them get this done pronto – no delay!  If the appeal isn’t filed in the ten day window, your clients’ right to keep their hours stops until the appeal is received.  This can cost you a lot!

Second, don’t let your client file their own appeal, especially without your home health care agency being named as representative!  Why so? Simple:  clients will be confused and intimidated and will not know what to say without you; CCME won’t give you key hearing dates, so your staff will not play a role; DMA will keep the result of the appeal a secret from you; and you will pay the aide but DMA won’t pay you.

Third, DMA has finally set some standards which CCME and other vendors will have to meet in handling appeal cases.  CCME must get the Maintenance of Service authorization completed within five business days from their receipt of the appeal.  So, keep your fax transmit report, to prove when the appeal was sent!

This posting adds to the advice in October 2010 Basic Medicaid Billing Guide, found on DMA’s site at:

http://www.ncdhhs.gov/dma/basicmed/index.htm

You can visit this page often for some tips but imagine the information you get if you’re our customer.  At SembraCare, our expertise and tech tools max your money while you work on building and maintaining  your home health client base.  We scour the web for the info you need, and we break it down here, http://www.sembracare.com/category/latest-news/, saving you time and headaches.

Filed Under: Latest News Tagged With: , ,

DMA Publishes New Clinical Coverage Policies

November 1, 2010 By

On October 29, 2010 North Carolina Division of Medical Assistance published two new proposed Clinical Coverage Policies for In Home Care Adults (IHCA) and In Home Care Children (IHCC), which are intended to replace the existing PCS/PCS Plus program. DMA is looking to close down the existing PCS and PCS Plus programs as soon as possible after January 1, 2011. The new replacement Policies have a 45 day comment period.

The most important aspect of the new proposed policies would be the change in the minimum requirements for PCS eligibility. Under current Policy 3C, a recipient must have two ADLs assessed as needing at least limited assistance. Under the proposed new IHCA policy, recipients must have at a minimum two ADLs, of which one must be at least rated as needing extensive assistance, or a minimum of three ADLs rated as needing at least limited assistance.

The new policies may be accessed here: http://www.ncdhhs.gov/dma/mpproposed/index.htm

Filed Under: Latest News Tagged With: ,

Important Notice for PCS Providers About CCME Errors and Fixes

August 16, 2010 By

DMA confirmed today that, prior to this week,  the “end dates” for Medicaid benefits from PCS recipients were calculated wrong by CCME due to a miss-communication with the programmer about what the effective end dates should be.  This error affected 100% of the 1,089 individuals who were sent cut-off letters, and was brought to DMA’s and CCME’s attention by SembraCare.

A fix has been devised and will be implemented this week, so that end dates will henceforth occur on the correct date, and not before.  SembraCare clients do not need to take further action, as we will re-bill these items for you until they pay properly.

A second and separate problem has arisen from CCME’s failure to properly note the recipients’ rights to continuance of service even though they take appeals from CCME reductions or denials of benefits.

We recently demonstrated this error to DMA and CCME as well.  In response, DMA and CCME have now established a method of restoring coverage for PCS recipients who take appeals.  According to the CCME website, authorizations will be restored by CCME without the need for further action by providers or recipients for those PCS recipients who appeal within about ten days after the appeal is lodged.  CCME is unable to get copies of recipient appeal notices in time to adjust the end dates properly and prevent a cut off, and so is having to go back and make the adjustment after the fact.  Again, SembraCare customers will not have to take action to address this issue, as we will re-bill the time for you.

Filed Under: Latest News Tagged With: ,

DMA – The need to remove prohibited task from care plans

April 13, 2010 By

DMA is reemphasizing the need to remove prohibited tasks from care plans by April 30, 2010.   We quote:

The new PCS and PCS-Plus Clinical Coverage Policy 3C includes changes required by Session Law 2009-451 (Senate Bill 202). Section 10.68A.(a)(3) of Senate Bill 202 mandated the addition of the following items to the list of tasks that are not covered by the Medicaid PCS program:
•    nonmedical transportation
•    errands and shopping
•    money management
•    cueing, prompting, guiding, and coaching
These and other non-covered tasks are listed in Section 4.3 of the new Clinical Coverage Policy.
Nonmedical transportation includes transporting a recipient outside of or away from the recipient’s residence. Errands and shopping include making purchases or performing other tasks for the recipient outside or away from the recipient’s residence. Such tasks are not covered under the PCS policy and must be eliminated from recipient POCs. In living communities in which laundry or other facilities are located outside the recipient’s private apartment but on-site, these on-site facilities are considered to be part of the recipient’s residence.

Filed Under: Latest News Tagged With: ,

Medicaid Announces Public Hearing on Bond Rules

February 1, 2010 By
The Department of Health and Human Services, Division of Medical Assistance will hold a public hearing for Medical Assistance Eligibility, Provider Enrollment, Provider Performance Bond rules published January 4, 2010

The public hearing will be held 10:00 a.m., Wednesday, February 17, at Dorothea Dix Campus, Kirby Building room 132 (1985 Umstead Drive, Raleigh, NC 27603).

Verbal comments will be accepted for the following rules:

10A NCAC 22N .0401 – Default
10A NCAC 22N .0402 – Requirement for Provider Performance Bonds 10A NCAC 22N .0403 – Definitions

Concerns should be directed to Teresa Smith, DMA Rule-making Coordinator, by e-mail at Teresa.Smith@dhhs.nc.gov.

What to do:

Providers should study these rules now to determine whether they would be required to post a bond, and, if so, begin making arrangements to be able to do so at the time the Rules go into effect. If you have comments, send them to DMA or attend the Public Hearing to express your views.

Posted by SembraCare
Filed Under: Latest News Tagged With: ,