Category: Medicaid
HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
CMS Increased Payment for Influenza Vaccines
On August 1, the Centers of Medicare and Medicaid Services (CMS) increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.
Texas Medical Association billing and coding staff caution that to receive payment, physicians also will need to use a national drug code (NDC) associated with the current period.
Follow this link for proper CPT codes and more vaccine information.
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
Co-pays Resuming for Certain Services
Effective 10/1/24: Co-pays will Resume for CHIP CoVid19 Services.
During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for Children’s Health Insurance Program (CHIP) members. This waiver will end on September 30, 2024
Providers may begin collecting co-pays for COVID-19 vaccines, testing, and treatment rendered to CHIP eligible members for dates of service on or after October 1, 2024.
Providers may not charge co-pays for mental health and substance use disorder outpatient office visits
Co-pays have been permanently removed for mental health and substance use disorder outpatient office visits to comply with federal regulations.
Information for Medicaid Providers
Upcoming Changes to STAR+PLUS
Effective September 1, HHSC is transitioning contracts for the STAR+PLUS program. Below are a few resources that may help.
If you need help with….
Try…
Managed Organization Complaints.
Knowing how this transition will impact my billing.
Please reach out to the MCO to understand their billing process.
Helping your clients through the transition.
See the HHSC Star+Plus webpage for transition resources.
For any STAR+PLUS transition related issues, please contact the STAR+PLUS Go Live Inbox.
And as always, contact POET if you have any concerns.
HHSC Extends Postpartum Coverage.
Effective March 12, 2024, women enrolled in Medicaid or CHIP who are pregnant or become pregnant will be automatically enrolled for 12 months of postpartum coverage (formerly only 2 months).
Medicaid or CHIP coverage will be automatically extended to women while pregnant and still within their 12-month postpartum period if they are still residents of Texas. Coverage will be reinstated for the remainder of the 12-month postpartum period.
Superior Records Retrieval Project
It is always good to know things before they occur. But often we are scrambling for information after the fact.
NOT THIS TIME
Superior gives us a Heads Up.
Superior is requesting your cooperation in providing access to specific member records to facilitate a Risk Adjustment chart review. Risk Adjustment is the payment methodology used by CMS and HHS for Wellcare By Allwell and STAR+PLUS Medicare-Medicaid Plan.
The purpose of these chart reviews is to verify that information reported to Superior, and ultimately to CMS and HHS via claims or encounter data, includes all pertinent diagnosis codes at accurate levels of specificity.
Please Note: Superior has executed a Business Associate Agreement with both Advantmed and Datavant (formerly CIOX Health).
Advantmed and Datavant have been engaged by Superior to retrieve medical records selected as part of this chart review. Any information shared during this review will be kept in the strictest of confidence, in accordance with all applicable state and federal laws regarding the confidentiality of patient records, including current HIPAA requirements. Superior appreciates your cooperation with this and will work with you to minimize disruptions in member care.
You will have the option to submit medical records in the following ways:
- Secure email
- Fax
- FedEx
- Remote Electronic Medical Record (EMR) download
AND
- Onsite scanning performed by an Advantmed medical record technician
Tell your staff to anticipate a call or fax from Advantmed or Datavant to schedule the medical record retrieval in the upcoming weeks.
For any questions, please email [email protected]
HHSC: Star+Plus Webinars
HHSC is transitioning contracts for the STAR+PLUS program effective September 1, 2024.
They will be conducting webinars to assist with the STAR+PLUS transition as this change will affect both members and providers.
ONLY TWO SESSIONS LEFT
Saturday June 22nd, 9:00-10:00 AM
Monday June 24th, 1:00-2:00 PM
Cyberattack Added to MIPS Hardship Exemption
Due to the ongoing impact of the Change Healthcare cyberattack on an increasing number of physician practices, the Centers for Medicare & Medicaid Services (CMS) has added an option to cite the cyberattack when requesting a hardship exemption within the 2024 Merit-based Incentive Payment System (MIPS).
CMS has added the option to the Extreme and Uncontrollable Circumstances (EUC) application. The 2024 MIPS EUC portal is now open, and physicians have until Dec. 31 to file a hardship application and avoid a 2026 MIPS negative payment adjustment
Avoid Medicaid Disenrollment
Physicians Must Validate Email to Avoid Medicaid Disenrollment, Payment Delays
By Emma Freer
Texas Physicians who care for Medicaid patients should confirm their email address is valid in the Texas Medicaid and Healthcare Partnership’s (TMHP’s) Provider Enrollment Management System (PEMS) to ensure effective communication and timely payments from the state Medicaid administrator.
Without a valid email address on file in PEMS, clinicians will not receive online correspondence from TMHP, including reminders regarding their upcoming revalidation due dates, or be able to start a revalidation request, among other consequences.
Clinicians who fail to complete their respective revalidations by their given due dates will be disenrolled from Medicaid.
For step-by-step instructions on how to add and verify your email address in PEMS, check out TMHP’s handout.
TMHP also encourages clinicians to add the “TMHP.com” domain to their safe senders list in their email system and to avoid unsubscribing from TMHP emails.
For more information, reach out to TMHP via email or by calling (800) 925-9126.
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