Dear CAMPS Member: 

 

The American Association for Homecare (AAHomecare) is preparing to engage in dialogue about the future of their organization and how they can best help the industry. They are seeking input from both members and non-members in a short 5 to 10 minute survey.

 

A researcher from Tecker Consultants is managing this project to ensure all survey submissions will remain completely anonymous. Individual responses are not available to AAHomecare and the data will only be reported in aggregate.

 

Please take the time to assist AAHomecare in planning for the future.

 

Click here to complete the survey.

 

For more information, please contact:

 

Tyler J. Wilson, President

American Association for Homecare (AAHomecare)

2011 Crystal Drive, Suite 725

Arlington, VA 22202

703/535-1888

 

 

CAMPS Successful in Correcting Medi-Cal Edit on Ventilators 

 

Below is the notice for the June Medi-Cal Bulletin that corrects an error in claims processing where a patient was approved for more than one ventilator, usually a CCS patient and a back-up ventilator. The second ventilator claim was being denied due to the new NCCI edits which were implemented this year.

 

NCCI/Medi-Cal Claim Processing Discrepancy: Ventilators

Some claims submitted for the following ventilator services were inappropriately denied due to differences between National Correct Coding Initiative (NCCI) edits and established Medi-Cal edits. Providers need take no action. An Erroneous Payment Correction will be implemented to reprocess affected claims. In addition, an override will be established in the Medi-Cal claims processing system so future claims will adjudicate correctly.

 

Note: NCCI edits were incorporated into the Medi-Cal claims processing system effective March 28, 2011. Efforts were made to anticipate discrepancies between established Medi-Cal edits and NCCI edits but it was understood some differences would be identified only as claims were processed.

 

Code

Description

Discrepancy

E0460

Negative pressure ventilator, portable or stationary

Claims denied because NCCI Medically Unlikely Edit (quantity) edit is 1. Medi-Cal quantity limit is 2, with authorization and justification of medical necessity.

E0461

Volume control ventilator, without pressure support mode, may include pressure control mode, used with noninvasive interface (e.g., mask)

Same as previous

E0463

Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheotomy tube)

Same as previous

E0464

Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask)

Same as previous