Posted by Behavioral Health Billing Solutions, LLC.
Ohio BH Redesign started January 1st, 2018 and the Managed Care carve in began July 1st, 2018. Every few months, I try to look at the overall picture and ask the question
“Where are we now?”
I believe most agencies think longingly of the time period between January 1st, 2018 and June 30th, 2018. Yes, it was painful and of course, some agencies weren’t ready. Many still to this day aren’t on an electronic health record.
However, once ODM got all the kinks worked out of the system, for agencies who were current on the coding changes and the fact that we had to bill third party liability (even though the MITS system was incorrect), it was okay.
At some point during those 6 months, ODM decided in addition to the carve in, they wanted ALL providers, licensed and unlicensed, to be registered in the State of Ohio. That decision might be what broke the camel’s back. However, the MCO’s stood and swore they were ready and the state believed them.
That’s when things really got bad. There were a multitude of errors in the adjudication systems of the MCO’s, agencies didn’t realize all providers needed registered and everyone underestimated the amount of providers that one change would impact. Now, one year and 3 months past the carve in, the MCO’s adjudication is still wrong. In addition, the MCO’s eligibility information for clients does not match ODM’s which causes multiple issues with correctly recording third party liability.
And all of a sudden, even the things that appeared fixed are now broken again. See below for the latest incorrect denials and short pays we are seeing in September 2019 at BHBS.
Incorrect Denial for Service not contracted
Incorrect Denial for Diagnosis
Incorrect Denial for Invalid Claim Form
Incorrect Denial for Missing Prior Auth
Incorrect Denial for Missing Rendering
Incorrect Denial for Provider Issue
Incorrect Denial for No Reason
Incorrect Short Pay for Licensed Provider
Incorrect Short Pay for Supervision
Incorrect Short Pay – Unknown rate
Incorrect Over payment
Incorrect Duplicate payment
Incorrect Over payment – Paid billed rate
Incorrect Denial for second service, different provider
Incorrect Short Pay for dropped add-on
Incorrect Short Pay for dropped Primary Code
At the same time, ODM is working with all agencies who took a contingency payment, to begin a payment schedule that ends in December 2020. Now while the timeline is okay, since the issues still have not been fixed and providers still have claims unpaid or paid incorrectly from July 1st, 2018 – December 31st, 2018, should they be required to pay anything yet? I’m recommending to our clients that they ask for an independent contractor to certify each MCO’s adjudications are correct before agreeing to any repayment agreement.
Now let’s talk about some of the recent changes made by OHMAS and ODM. We had a number of rate increases, including bringing CNP’s up to MD rates and a number of other rate changes. However, did you know that if you follow ODM’s guideline for SUD group and bill 16-52 as 90853 and H0005 for 53 and up, you cannot use location 99 for H0005 but you can for 90853?
They also added pregnancy tests, smoking cessation and increase breathalyzer to $22.50. In addition, they added pretty much all providers to TBS and increased the rate for crisis TBS. These were all positive changes, however they don’t do anything to correct the situation listed above.
This week, ODM announced a training for Community Behavioral Health Centers. The MITS BITS is available here.
The training is available in person (attendance is limited to 125) and via webinar.
The meeting will address certain topics that have been discussed with ODM and OhioMHAS over the course of the last few months. ODM and OhioMHAS thought it may be helpful to discuss these topics with CBHCs to ensure successful
implementation of Behavioral Health Redesign and Managed Care Integration and continued access to Ohioans in need of mental health treatment and addiction services.
State agency staff will present these topics to stakeholders and be made available for questions. Training topics will include:
• Provider enrollment
• Individual eligibility
• Prior authorization
• Claims submission and denials
Another issue that is occurring are the letters providers are receiving stating that a couple MCO’s have contracted with Change Healthcare to audit high use of psychotherapy codes.
As one of our clients reported to the director of Medicaid “Being a behavioral health agency, psychotherapy services are one of our main service lines. Can you please ask them to stop sending these letters?”
Another important change was announced over the last month. Effective 11/25/2019, CareSource will be requiring a prior authorization from day 1 for Partial Hospitalization. Please see below.
In addition, Caresource is making a change re: EFT/ERA management from Instamed to ECHO Health for EFT/ERA processing. Enrollment with ECHO Health is available NOW. DO NOT WAIT UNTIL THE LAST MINUTE or you may risk an interruption in your EFT deposits or ERA Routing from your clearing house.
There is no charge for registering with this service. The link to register with ECHO is available here.
And the Ohio Council annual conference is right around the corner. As many of you are aware, BHBS always encourage participation in the Council to our clients because they not only advocate for all agencies but they provide training and on-going information to their clients. Behavioral Health Billing Solutions will be in attendance this year. Please stop by and say hello!
Registration link for the conference can be found here.