2020 MO HealthNet Provider Hot Tips
The MO HealthNet Division provides hot tips to providers to assist them in receiving timely reimbursement for services provided. Please share these hot tips with your billing staff.
2020 Provider Tips Index
Physician & Laboratory Responsibilities for Drug Screening Services Billed to MO HealthNet: Reminders
February 11, 2020
The MO HealthNet Division (MHD) covers qualitative (presumptive) and semi-quantitative drug screening tests. These tests report what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration.
MHD only covers quantitative (definitive) or “confirmative” tests if there is a positive screen for the drug class to be quantified and if the physician has documented the medical necessity in the patient medical record.
Physician offices or clinics may bill for initial drug screens performed at the point of care or independent and/or hospital laboratories may bill for screenings they perform. Both providers cannot bill for the same date of service for the same participant.
The ordering physician has certain responsibilities:
- The ordering physician must coordinate the billing of the drug screen tests with the performing laboratory.
- The ordering physician must document medical necessity in the patient medical record when ordering quantification of a drug class or a confirmatory drug test.
- The ordering physician must sign each order for drug screening tests by signing a paper order, or by electronic signature that conforms with the requirements of 13 CSR 65-3.050. The requirements state that an electronic signature means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual with the intent to be the legally binding equivalent of the individual’s handwritten signature. The use of biometrics does not constitute an electronic signature; however, biometrics may be used as part of electronic signature verification. A signature stamp does not constitute an electronic signature.
The performing laboratory has certain responsibilities:
- The performing laboratory must ensure the physician has provided documentation of medical necessity when requesting quantification of a drug class or a confirmatory drug test.
- The performing laboratory must not perform quantification of a drug class or a confirmatory drug test without documentation of medical necessity.
Diabetes Training Opportunity for Behavioral Health Providers!
February 3, 2020
We are alerting you to a world-class behavioral health training for psychologists and other mental health professionals developed by the American Diabetes Association on Saturday, February 29, 2020, in Kansas City. The workshop is co-sponsored by the Missouri Psychological Association (MOPA) and the Kansas City University of Medicine and Biosciences.
ABOUT THE WORKSHOP: Lead speaker will be Dr. Doug Tynan, former Director of the Office of Integrated Care for APA and now with the American Diabetes Association. He will be accompanied by two other nationally recognized instructors in this area.
The workshop is offering a total of 12 CEs --- 7 at the workshop and 5 more online.
COSTS/REGISTRATION: Regular cost of the workshop is $295, but MOPA or Kansas Psychological Association members will receive a special $45 discount. You may find out more at www.mopaonline.org/diabetes.
WHY THIS WORKSHOP IS IMPORTANT: The CDC reports that more than 100 million Americans are now living with diabetes or pre-diabetes. It is the 7th leading cause of death in our country. Behavioral health issues are common.
Given the right education and background, there is a special place for psychologists and behavioral health professionals who wish to provide care to this group and a special opportunity to expand your practice.
Laboratory Panel Codes
January 7, 2020
The MO HealthNet Division (MHD) claims processing system can only process claims for laboratory panels if all of the procedure codes and units that are included in the panel are completed and submitted on the electronic claim.
For example, the laboratory panel for procedure 80426 includes four units of 83001 and four units of 83002. The provider must complete four units of 83001 and four units of 83002 in order to bill for 80426. This claim can be submitted electronically.
If a provider only completes one unit of 83001 and one unit of 83002 they cannot bill 80426. The claim for one unit of 83001 and one unit of 83002 must be submitted via paper claim to:
Department of Social Services
Attn: Lab/Transplant Unit
PO Box 6500
Jefferson City MO 65102
Provider Resources for Bereavement Training
January 3, 2020
There are several bereavement training opportunities offered by Share (Pregnancy & Infant Loss Support). Available are eight online training courses. Live presentations of Companion training and Memory Making are scheduled in February 2020.
Trainings are all available free of charge from a Missouri Foundation for Health grant. If you are interested in hosting a training or for further information, please email: email@example.com
To access these online learning courses: https://education.nationalshare.org/bundles/advanced-training-courses
Medicare Beneficiary Identification Number (MBI)
January 1, 2020
All Medicare claims submitted after January 1, 2020, are required to use the new MBI number. Effective January 1, 2020, claims filed without the MBI will deny for a mismatch of DCN/MBI combination not found in the MMIS.
The Medicare Access and CHIP Reauthorization Act (MACRA) required CMS to remove Social Security Numbers (SSNs) from the current SSN-based Health Insurance Claim Number (HICN)
Missouri Dual eligible Medicaid and Medicare participants have received their new cards.
If you have questions please call Provider Communications at 573-751-2896.