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IMA Admin Update
Medicaid "Zero Fill" and Retro Remittances
February 14, 2012
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IMA Admin UpdateHere is some more important information we want to share with you regarding Medicaid billing and remittances.
Medicaid "Zero Fill"
Here is some more information on the new limitations of using Medicaid "Zero Fill".
In our previous email we focused on "Zero Fill" at the service level (for services that Medicare does not pay for). Another common use of "Zero Fill" is at the service provider level (staff). If a client has Medicare/Medicaid and the service provider is not Medicare qualified, the common practice was to "Zero fill" these services. This would no longer be acceptable (particularly when the client had other billable services on the same day). All services would need to be billed to Medicare and only after a remittance can they be passed though to Medicaid.
In the IMA Staff Maintenance, there is a field labeled "Medicare Fee Type" which controls how this is handled. A "9" will "Zero fill" (auto-exclude) the services. A "0" will attempt to bill. If you need to start billing Medicare for these services the staff definition records would need to be changed from "9" to "0".
There is still an open question regarding whether an unrecognized service provider will make it through the Medicare pre-processing edits. Some have suggested that services should be sent with a GY modifier. We have not heard anyone that has tested this though and if indeed necessary, this can be configured as well in the staff definition "MC CPT Modifier" field.
If anyone has any more information on this please let us know ASAP.
Medicaid Retro Remittance
Please be aware that a number of customers have received very large retro remittances for services starting 4/1/2011 primarily to take back payments because of the 30/50 visit threshold rules. I think you can expect in the near future many such remittances for other rate adjustments.
In order to help with your analysis of these remittances we are creating a new report that will match reversals with new payments and differentiate between claims adjusted at the same or different rates. This new report should be available by the end of the week.
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