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 |