Provider Update
Volume 21, Issue 4
July/August 2004
BCSS Establishes Service Provider Enrollment and Provider Standards for Participation
in Home and Community-based Waivers
As a result of input from stakeholders, the Bureau of Community Supports and Services (BCSS) has put into place two initiatives to address quality of services provided by Home and Community-based Waiver Service Providers. These initiatives are as follows:
Service Provider Enrollment: A rule promulgated in the December 21, 2002 issue of the Louisiana Register mandates attendance at a one day orientation session prior to enrollment as a Medicaid provider of waiver services.
Standards for Participation: A rule promulgated in the September 30, 2003 issue of the Louisiana Register addresses the minimum standards which must be met in order to participate as a provider of waiver services.
The standards for participation for waiver service providers were established to ensure minimum compliance under the law, equity among those served, provision of authorized services and proper fund disbursement. All new agencies enrolling as waiver providers must comply with these standards prior to enrollment. Current providers of waiver services must comply with these standards by August 2005 through a re-enrollment process.
For more information on these quality initiatives, please visit the BCSS web site at www.dhh.la.gov/BCSS or call the BCSS Toll Free Help Line at 1-800-660-0488.
Claims Status Inquiry (e-CSI) Web Application Update Access Issues Identified
The Louisiana Medicaid Claims Status Inquiry Application (e-CSI) went into production recently. This new HIPAA 276-277 transaction allows web-enrolled providers to obtain the status of claims submitted to Louisiana Medicaid. The application can be found in the secure area of the Louisiana Medicaid web site, www.lamedicaid.com. Claims that have entered the processing system and are either pending, paid, or denied may be viewed.
Since its release, the application has undergone some cosmetic and informational changes to make it more user-friendly and allow presentation of more complete, understandable information.
To ensure appropriate security of recipient's patient health information (PHI) and provider's personal information, the secure area of the web site is available to providers only. It is the responsibility of each provider to become "Web Enrolled" by obtaining a login and password for this area of the site to be used with his/her provider number. Once the login and password are obtained by the provider who "owns" the provider number, that provider may permit multiple users to login using the provider number. This system allows multiple individuals to login using the same login and password OR a provider may have up to 500 individual logins and passwords established for a single provider number. The administrative account rights are established when a provider initially obtains a login and password, and should remain with the provider or designated office staff employed by the provider.
A login and password may be obtained by using the link, Provider Web Account Registration Instructions. Should you need assistance with obtaining a login and password or have questions about the technical use of the application, please contact the Unisys Technical Support Desk at 877-598-8753. A detailed user guide on how to use the CSI application is in development and will be available shortly by selecting the HELP button from within the application.
Unisys has received inquiries from billing agents/vendors attempting to access this web application. DHH and CMS Security Policy restrictions will not permit Unisys to allow access of this secure application to anyone except the owner of the provider number being used for accessing the site. In cases where an outside billing agent/vendor is contracted to submit claims on behalf of a provider, any existing business partner agreement is between the provider and the billing agent/vendor. Unisys may not permit anyone except the provider to receive or ask for information related to a login and password to access secured information.
Effective immediately, providers wishing to check the status of claims submitted to LA Medicaid should use this application. We are required to use HIPAA compliant denial and reference codes and descriptions for this application. If the information displayed on CSI is not specific enough to determine the detailed information needed to resolve the claim inquiry, refer to the hard copy remittance advice. The date of the remittance advice is displayed in the CSI response. The hard copy remittance advice continues to carry the Louisiana specific error codes. Providers must ensure that their internal procedures include a mechanism that allows those individuals checking claims statuses to have access to remittance advices for this purpose.
A LA Medicaid/HIPAA Error Code Crosswalk is available on the lamedicaid.com website by accessing the link, Forms/Files.
Please allow ample time for your claims to enter the processing system before attempting to inquire through CSI. Providers should wait approximately one week for electronic submissions and approximately three to four weeks from receipt (not including mailing time) for hard copy claims.
NOTE: When entering search criteria, it is important to remember that each claim line is considered A CLAIM for processing purposes. A provider inquiring on a multiple line claim should either check the status of EACH claim line OR inquire on the claim without entering an amount in the "Amount Field".
Documentation of Services
Documentation in case records provides an ongoing �picture� of the progress an individual makes toward achieving outcomes and is the basis for decisions and recommendations for supportive services. For this reason, documentation of activities is not linked to minute increments, but rather describes the activity(s) over a period of time.
While HIPAA requires billing to be recorded in 15 minute increments, this is not necessarily a requirement of documentation. Unless the activity only takes 15 minutes, such as the administration of medication, then documentation would cover the period of time the activity took place. Documentation must be completed at the end of each shift for each service delivered.
An example of an adequate progress note would be a shopping trip with the direct support worker to the mall that occurs over a 3 hour time period, where the time is documented in a summary. Staff would not be required to document every 15 minutes to describe the ongoing activities. The adequate progress note could be written in summary form describing the time the person left for the shopping trip, the staff who accompanied them, a summary of the activity such as: possibly purchases made, a meal or snack eaten, a movie that was attended, and the time they returned home noting the progress made toward achieving the individual�s personal outcomes.
An exception to this style of documentation occurs when a critical incident occurs. Critical incidents must always be part of documentation per BCSS policy.
Documentation is not intended to be intrusive or an embarrassment to anyone. It should describe the quality and quantity of services rendered, as well as provide accountability for the agency.
For further information regarding documentation, please refer to Provider Services Manual.
Dental Providers
General Information
Dental services must not be separated or performed on different dates of service solely to enhance reimbursement.
Dental Sealants
If no restorative or other treatment services are necessary, all sealants must be performed on a single date of service. If restorative or other treatment services are necessary, sealants may be performed on the same date of service as the restorative or other treatment services.
Restorative Services
Unless contraindicated, all restorative and treatment services per quadrant must be performed on the same date of service. This allows the dentist to complete all restorative treatment in the area of the mouth that is anesthetized. In addition, if there is a simple restoration required in a second quadrant, the simple restorative procedure in the second quadrant must also be performed at the same appointment. If there are circumstances that would not allow restorative treatment in this manner, the contraindication(s) must be documented in the patient�s dental record.
Radiographs
A lead apron and thyroid shield must be used when taking any radiographs reimbursed by the Medicaid Program. When taking radiographs, the use of a lead apron and thyroid shield is a generally accepted standard of care practice and is part of normal, routine radiographic hygiene.
Should you have any questions regarding this information, you may contact a Medicaid dental consultant at the Dental Medicaid Unit by calling 504-619-8589.
Date of Service Reminder
We want to remind all Durable Medical Equipment (DME) Providers that the date of service on claims must always reflect the actual date of delivery. It is a violation of Medicaid Policy to submit a request for payment prior to the date of delivery or to show the date of service as any date other than the actual date of delivery.
Notice to All Medicaid Providers
One of the goals of CommunityCARE is to reduce routine care being inappropriately provided in the high cost emergency room setting. Medicaid is aware of the Emergency Medical Treatment and Labor Act (EMTALA) requirement. Although hospitals are required by EMTALA to provide a medical screening exam (MSE) to all persons who present to the emergency room, Medicaid does not reimburse for the EMTALA required exam. After the MSE is completed, and is determined that an emergency condition does not exist, the recipient should be advised that their condition is not emergent and should then be referred back to his/her PCP. If it is determined that the presenting symptoms do not meet the Federal prudent lay person standard (see below), the EMTALA required exam is billable to the enrollee. However at the time of the visit, the enrollee must be advised that they may be responsible for the bill and it should be documented in the chart. As you know, "if it isn't documented, it didn't happen."
CommunityCARE PCPs are not expected to post-authorize emergency room visits unless the person has presenting symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possess an average knowledge of health and medicine, could reasonably expect the absence of medical attention to result in:
� Placing the health of the individual (or in the case of a pregnant woman, the health of the woman
or her unborn child) in serious jeopardy
� Serious impairment to bodily function
� Serious dysfunction of any bodily organ or part
PCP Linkage Limits
The CommunityCARE Handbook, section 3.1.2, discusses the maximum numbers of recipients allowed to be linked to enrolled PCPs. This means that even though a PCP may have "open" panels, if the PCP has exceeded their limit, enrollees will be told that, the PCP being selected is not available as a choice for new patients. Additional linkages will be allowed only in cases where a recipient has an existing medical relationship with the provider, or in the case of PCPs who panel is open for newborns.
PCPs that have exceeded their limits and are accepting newborns into their practice will be able to continue to receive newborn linkages. However, when the mother receives the CommunityCARE choice letter -- if she does not call to choose a PCP for that baby, the baby will be randomly assigned, because claims for newborn services typically are not in the system by the time CommunityCARE assignments are made. Therefore, PCPs who want to continue to grow their practice via newborn linkages must educate the parents about the notice they will be receiving from CommunityCARE, and emphasizing that they must call the 1-800 number and select them as the baby's PCP if they want to continue getting care from them.
Referral/Authorizations
It has come to the State's attention that some CommunityCARE PCPs are requiring enrollees to go to the PCP' s office to personally pick-up referral authorizations. This practice is contrary to the national goal to increase access to care for the enrollee. Medicaid recipients, as a population, traditionally have issues with transportation. CommunityCARE considers this practice �unreasonable withholding of a referral authorization.� PCPs shall not require recipients to travel to the PCP's office to obtain a document which can be mailed or faxed.
Many providers are reluctant to issue transitional authorizations without having seen the patient in their office for care. The "transitional" authorization is not a medical referral and does not imply that the current PCP has suggested or endorsed any particular medical service/treatment. Therefore, there is no need for the PCP to see the patient in his/her office prior to issuing a transitional authorization. If the current PCP wants to confirm that the change request has been made, he/she can call the CommunityCARE Enrollee Hotline at (800)609-3888.
In some instances enrollees will make an appointment with , or present at, a PCP�s office whom they are not linked to. When the enrollee presents to that office they are advised that they must change PCPs before they can be seen, then, that office contacts the current PCP�s office stating that the person has changed PCPs and requests a transitional authorization beginning with that date of service.
This scenario is NOT the intent of the transitional authorizations.
CommunityCARE Correction
In the May/June issue of the Provider Update, paragraph 2 of an article titled, �Notice to PCPs,�states, �The PCP will carefully review the emergency room face sheet and pertinent copies of the emergency room record forwarded by the emergency department for visits with CPT codes 99281, 99282, and 99283 for post authorization.�
CPT code 99283 should not have been included in that statement. Only emergency room visits codes 99281 and 99282 are forwarded to the PCP for post authorization review. Emergency room visits coded 99283, 99284,and 99285 do
not require a PCP referral authorization.
Breast and Cervical Cancer Program Covers Treatment for Uninsured Women
Providers can help inform the public about the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program. Louisiana Medicaid now provides full Medicaid benefits to eligible women who have been diagnosed with breast or cervical cancer or a pre-cancerous condition and are in need of treatment.
The Breast and Cervical Cancer Early Detection Program is administered by the Women�s Preventive Health Program. It is operated by the LSU Health Sciences Center, which has partnered with other medical providers to give breast and cervical cancer screenings. Eligible women will be referred to one of the providers listed in Table 1 to get a medical screening. If breast or cervical cancer is diagnosed, the LSU partner will assist with completion of a simple two-page Medicaid application. This information will be sent by the LSU partner to the local Medicaid office, where a decision will be made.
| Table 1. Providers |
| Region |
Provider |
Telephone No. |
| 1 |
Partners in Health
Stanley S. Scott Cancer Center, LSUHSC New Orleans |
(504)599-0529 |
| 1 |
Medical Center of Louisiana at New Orleans (MCLNO) |
(504)903-5087 |
| 1 |
MCLNO Breast Education Resource Center |
(504)903-1172 |
| 2 |
Earl K. Long Medical Center
Baton Rouge, LA |
(225)358-1300 |
| 2 |
Women�s Hospital
Baton Rouge, LA |
(225)924-8264
(225)924-8242 |
| 3 |
Chabert Medical Center
Houma, LA |
(985)873-2226
(985)873-1757 |
| 4 |
University Medical Center
Lafayette, LA |
(337)261-6727 |
| 5 |
Moss Regional Medical Center
Lake Charles, LA |
(337)675-8175
(337)475-8818 |
| 6 |
Huey P. Long Medical Center
Pineville, LA |
(318)473-6247 |
| 7 |
Partners In Wellness
Feist-Weiller Cancer Center
LSUHSC - Shreveport |
(318)675-5781 |
| 8 |
EA Conway Hospital
Monroe, LA |
(318)330-7571 |
| 9 |
Lallie Kemp Regional Medical Center
Independence, LA |
(985)878-1647 |
Eligible women must be U.S. citizens or qualified aliens, under 65 years old, uninsured, and screened for breast or cervical cancer under the CDC Breast and Cervical Cancer Early Detection Program and found to need treatment for either breast or cervical cancer. In addition, the CDC requires that income be less than 250% of the Federal Poverty Guidelines (FPG).
Table 2 shows the income amounts.
|
Table
2. Income Amounts � 250% of
FPG
|
|
Family Size
|
Gross Annual
Income
|
Gross
Monthly Income
|
|
1
|
$23,275
|
$1,940
|
|
2
|
$31,225
|
$2,603
|
|
3
|
$39,175
|
$3,265
|
|
4
|
$47,125
|
$3,928
|
|
5
|
$55,075
|
$4,590
|
|
6
|
$63,025
|
$5,253
|
|
7
|
$70,975
|
$5,915
|
|
8
|
$78,925
|
$6,578
|
Eligibility continues until the course of treatment ends or the criteria for the program are no longer met. Eligibility may begin up to three months before the month a woman applies for Medicaid. A woman may be eligible to be paid back for medical services received up to three months before she applied if she is eligible for the date the service was received, she used a Medicaid provider, and the service is covered by the Medicaid program.
For more information, visit the Medicaid website (www.dhh.state.la.us/MEDICAID).
Crossover Codes
As per Medicare policy, the following codes have been made payable effective January 1, 2004 for crossovers only.
G0317 - Dialysis, 4 or more visits per month - $289.72
G0318 - Dialysis, 2-3 visits per month - $241.19
G0319 - Dialysis, 1 Physician visit per month - $192.67
G0323 - Management of Home Dialysis (entire month) - $241.19
G0327 - Management of Home Dialysis (partial month only) - $8.22
Fees which were incorrectly loaded for procedure codes G0317, G0318, G0319, and G0327 have been revised. Recycle of previously denied claims and adjustments of previously paid claims will appear on forthcoming Remittance Advices.
CPT Code Requiring a QW Modifier
Effective with the indicated date of service the following CPT procedure codes will be added to the list of codes which require a QW modifier.
CPT 87899 effective 08-21-03
CPT 86701 effective 09-30-03
CPT Code 83880
CPT code 83880 was in non-pay status and erroneously listed on our files as Assay Nalorphine. CPT code 83880 (Natriuretic Peptide) has been corrected and placed in pay status effective for date of
service January 1, 2003.
Claims with dates of service past one year should be submitted hard copy with proof of timely filing to Unisys Provider Relations.
Procedure Code 59409
Procedure code 59409 has been made payable effective March 1, 2003. Previously denied claims will be recycled by the Department and will appear on a Remittance Advice in the near future. The reimbursement for this code will be $697.26. When this code was implemented, the reimbursement for CPT code 59410 was inadvertently reduced to $697.23. All claims for CPT 59410 that paid at this reduced rate will be recycled and adjusted to receive the correct reimbursement of $774.00 on a Remittance Advice in the very near future.
Correction to Audiologist Notice
Effective with date of service July 1, 2003, the following CPT procedure codes will be added to the list of codes payable to Audiologists.
92541 92543 92544
92545 92547
* In the previous Provider Update this notice appeared under the Ultrasound section.
Billing for Extended Skilled Nursing Services
Prior to the implementation of HIPAA, when an agency billed for extended skilled nursing services (Home Health), agencies used the codes X9902 and X9907 (multi-recipients). It did not matter if the RN or LPN performed the service, they were paid at the same rate.
With HIPAA implementation, Medicaid mapped 2 separate codes (S9123 for RN and S9124 for LPN). The only time an agency needs to use a modifier is if there are multi-recipients. At that time, the agency would request and bill a TT modifier.
As per this notice, Prior Authorization requests for S9123 or S9124 will be denied if any modifier other than TT is requested.
If questions arise regarding this notice, please contact Dawn Matte, Program Coordinator, at
(225) 342- 1247.
Ultrasound Policy Change
Effective for dates of service on or after July 1, 2004, the reimbursement policy for ultrasounds during pregnancy has changed. Only 3 ultrasounds will be paid during a 270 day period, between both the Hospital Program and the Professional Services Program. This includes ultrasounds performed in an acute care hospital on an outpatient basis.
Hospice Eligibility
MEVS is now reporting Hospice eligibility. When checking Medicaid eligibility, please review the information carefully and check for Hospice Enrollment. Recipients who are enrolled in Hospice may be admitted to the hospital but the Hospice agency is responsible for payment if the inpatient stay is related in any way to the patient�s terminal illness. Please coordinate all services with the family and the hospice provider to ensure appropriate policy is followed.
Louisiana Drug Utilization Review (LADUR) Education
Hepatitis C Testing and Prevalence
By
W. Greg Leader, Pharm.D.
Associate Dean and Director School of Pharmacy
The University of Louisiana at Monroe
Anand Dalal, Ph.D. Candidate School of Pharmacy
The University of Louisiana at Monroe
Issues...
� Hepatitis C is the most common blood-borne pathogen in the United States.
� Seven to twenty percent of cases of chronic HCV infection will progress to cirrhosis in two to three
decades.
� Today, IV drug abuse is the primary route of transmission.
Introduction
Hepatitis C is caused by an RNA flavivirus (hepatitis C virus [HCV]) and is the most common bloodborne pathogen in the United States. Hepatitis C is the leading cause of chronic hepatic disease, and chronic HCV infection can lead to decreased quality of life as well as cirrhosis and hepatic carcinoma.1,2,3,4 Currently, chronic HCV infection is the most common indication of hepatic transplantation.5 This is part 1 of a two part series on hepatitis C. Information concerning the prevalence and testing in the Louisiana Medicaid population was obtained retrospectively from the Louisiana Medicaid Claims Database for patients continuously enrolled in the Louisiana Medicaid Program from 1999 though 2001.
Prevalence and Epidemiology
The prevalence of HCV infection appears to be low in the general U.S. population, occurring in approximately 2.3% of adults > 20 years of age with 55% to 84% of this population having chronic infection.
For the Louisiana Medicaid population, prevalence was defined as a paid claim with a hepatitis C diagnosis. Data collected from paid claims for continuously eligible Louisiana Medicaid patients indicated the following:
� 0.71% of the Louisiana Medicaid population
� 12.3% of the population receiving dialysis
� 14.1% of recipients diagnosed with hemophilia
� 9.18% of diagnosed drug abusers
� 8.53% of patients infected with human immunodeficiency virus
Seven to twenty percent of cases of chronic HCV infection will progress to cirrhosis in two to three decades.1,6 African Americans and Caucasians have a similar prevalence, whereas the Hispanic population has a higher infection rate. The highest incidence of new infections occurs in persons 20-39 years of age with more infections occurring in males than females. Although the impact of ethnicity has not been well studied in the United States, older age at the time of acquisition is associated with a more progressive course.7 The proportions of Louisiana Medicaid patients infected with HCV described by gender, race and age are depicted in Figure 1.
HCV is primarily a bloodborne pathogen with the major route of transmission being blood transfusions prior to 1992. Today, IV drug abuse is the primary route of transmission. Transmission between sexual partners can occur, but it is not an efficient route of transmission. Co-infection with HIV appears to increase sexual transmission.8 Up to 40% of patients can acquire HCV infection by an unknown unidentifiable route. It is suspected that tattoos and body piercing may contribute to infection in this population.5
Figure 1. Demographics of Louisiana Medicaid Recipients Diagnosed with HCV Infection (N=2128)
Health care workers are at risk for contracting HCV infection from inadvertent needle sticks. Although HCV is not transmitted as efficiently as hepatitis B via this route, the risk of transmission is greater than that of HIV. Despite this, the prevalence of HCV in healthcare workers does not appear to be greater than that of the general population.
Five-year survival rates for uncomplicated chronic hepatitis C infection are greater than 90%; however, the five-year survival rate among chronically infected patients developing decompensated cirrhosis is approximately 50%. These numbers translate into approximately 8,000 to 10,000 deaths each year attributable to hepatitis C. The majority of patients currently infected with hepatitis C are 30-49 years of age, and thus, the number of deaths from hepatitis C associated liver disease is expected to increase over the next two decades.
Risk Factors
Risk factors for HCV infection may include the following:5,7
� Blood transfusion or organ transplant prior to 1992
� Exposure to infected blood
� Hemodialysis
� Illegal drug abuse
� High risk sexual behaviors
� Tattoos
� Body piercing
Intravenous drug abuse appears to be the greatest risk factor with an odds ratio of 18.4-29.2 and both marijuana and cocaine abuse have been associated with an increased risk. It is speculated that marijuana and cocaine abuse may be surrogate markers for intravenous drug abuse. There is some debate concerning the role of tattoos and body piercing as risk factors, but recently, a study has implicated tattoos with HCV seropositivity (Adjusted odds ratio 6.5; 95% CI 2.9-14.4).
Sexual transmission among monogamous partners is rare with only 5% of spouses and monogamous partners being infected. Other studies have estimated the risk of infection from a hepatitis C infected partner to be as low as 1.5% in a long-term monogamous relationship. Transmission of the virus from an infected mother to a fetus occurs rarely with approximately 5% of infants infected.
Testing
Recently, the U.S. Preventive Services Task Force published guidelines on screening for HCV infections in adults. The Task Force found that, because of the low prevalence and lack of significant major health outcomes in the general population, routine testing in asymptomatic adults who are not at increased risk for infection (general population) is not warranted. The Task Force also found that there was insufficient evidence to recommend for or against the routine screening of HCV infection in adults at high risk. In part, this recommendation comes from the fact that, although current treatments appear to improve intermediate outcomes, there is no evidence that current therapy improves long-term outcomes.1 These recommendations contradict those currently published by the National Institutes of Health (NIH) Consensus Panel and the Centers of Disease Control. Both of these groups recommend the routine screening of high-risk populations.
The NIH consensus panel recommends the establishment of screening tests for all groups at high risk of HCV infection including:9
� Intravenous drug users
� Incarcerated individuals
� Blood transfusion prior to 1992
� Solid organ transplantation from infected donors
� Unsafe medical practices
� Occupational exposure to infected blood
� Birth to an infected mother
� Sex with an infected person
� High risk sexual practices
� Possibly intranasal cocaine use
The Centers for Disease Control, in its 2001 National Hepatitis C Prevention Strategy recommends the following persons for routine HCV testing:10
� Persons who have ever injected illegal drugs, including those who have injected once or a few times many years ago
� Persons who received a blood transfusion or organ transplant prior to July 1992
� Persons who received clotting factor concentrates produced prior to 1987
� Persons who were ever on long term dialysis
� Children born to HCV-positive women
� Healthcare, emergency medical, public safety workers after needlesticks, sharps, or mucosal exposure to
HCV-positive blood
The proportion of Louisiana Medicaid patients with identifiable risk factors for HCV infection that were tested for HCV is shown in Figure 2.
Patients suspected of being infected with the hepatitis C virus should be tested for the presence of the hepatitis C antibody (anti-HCV) in the serum. This test is performed using an enzyme immunoassay and has a high specificity and sensitivity detecting the anti-HCV in 97% of infected patients.10 False negatives occur rarely, and usually occur between exposure and seroconversion in patients infected with the human immunodeficiency virus, patients receiving chronic dialysis, and immunosupressed patients (e.g., transplant patients). False positives are less common and usually occur in the testing of healthy blood donors. In cases where false positives are suspected (no risk factors, normal liver enzyme tests), a confirming test such as the recombinant immunoblot assay (RIBA) should be used to confirm or deny infection.10
Patients who test positive for the anti HCV should have a qualitative test for hepatitis C viral ribonucleic acid (HCV RNA), particularly those patients with normal liver enzyme tests. The presence of HCV RNA indicates an active viral replication, and in immunocompromised individuals, identifying HCV RNA using PCR may be the only way to obtain a positive diagnosis. Unlike the measurement of viral loads in patients with human immunodeficiency virus, hepatitis C viral loads do not appear to correlate well with disease severity or prognosis; however, they provide information on the likelihood of response in patients
receiving anti-viral therapy.
<>
*Includes tests billed by independent laboratories but not by hospital outpatient
laboratories.
Once diagnosed, the severity of hepatitis C should be assessed. Liver enzyme tests do not
correlate well with chronic disease severity. Serum albumin, bilirubin and prothrombin time do appear to correlate with disease severity, but are usually not elevated until there is severe liver
damage. Therefore, in patients with chronic hepatitis C, a liver biopsy to determine disease severity should be considered. In patients abstaining from alcohol and having a known duration of infection less than 10 years, a biopsy may lend little to evaluation; however, in those patients with a history of heavy alcohol use or duration of infection greater than 10 years, biopsies are recommended. In all patients, liver biopsy may be helpful in guiding therapy.9
Patients testing positive for anti HCV should also be tested for concomitant diseases that share similar transmission profiles such as hepatitis B and HIV. In addition, immunity to hepatitis A and B should be assessed, and if it does not exist, the patient should be immunized against hepatitis A and B. The patient's iron stores should also be assessed, as iron overload has been associated with an increased risk of fibrosis. Finally, hepatitis C genotyping should be considered. The most common genotypes in the United States are 1a and 1b; unfortunately, these genotypes are also less likely to respond to alpha-interferon therapy.
References
1. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 1998; 47 (No. RR-19):1-39.
2. Alter HJ, Seef LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis. 2000; 20:17-35.
3. Foster GR, Golden RD, Thomas HC. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology. 1998; 27:209-12.
4. Seef LB. Natural history of chronic hepatitis C. Hepatology. 2002; 36:S35-46.
5. Haley RW, Fischer RP. The tattooing paradox: Are studies of acute hepatitis adequate to identify routes of transmission of subclinical hepatitis C infection? Arch Intern Med. 2003; 163:1095-8.
6. Freeman AJ, Dore GJ, Law MG, et al. Estimating progression to cirrhosis in chronic hepatitis C virus infection. Hepatology 2001; 34:809-16.
7. Chou R, Clark EC, Helfand M. Screening for Hepatitis C Virus Infection: A review of the Evidence for the US preventive Service Task Force. Ann Intern Med. 2004; 140:465-79.
8. Lauer GM, Walker BD. Medical Progress: Hepatitis C Virus Infection. NEJM. 2001; 345(1): 41-52.
9. Management of Hepatitis C: 2002. NIH Consensus State Sci Statements. 2002 June 10-12; 19(3): 1-46.
10. National Hepatitis C Prevention Strategy. Centers for Disease Control and Prevention.
http://www.cdc.gov/ncidod/diseases/hepatitis/c/plan/strategy.pdf. Accessed July 6, 2004.
Insert - 2004 Provider Fall Training Workshop Schedule
Announcing 2004 Unisys/Louisiana Medicaid Provider Workshops
Following is the schedule for the 2004 Fall Unisys Provider Workshops. The annual Unisys Provider Workshops focus on presenting vital policy and billing information to our Medicaid provider community. With that in mind, our intent is to create a neutral atmosphere for delivery of the educational materials to the providers in attendance. The Department of Health and Hospitals has asked Unisys Provider Relations to address questions relating to recent policy and procedure changes
Our training format separates basic information from specific program information. The Basic Medicaid information workshops will cover general Medicaid policy such as standards for participation, recipient eligibility/ID cards, third party liability, how to obtain assistance from Unisys, the Unisys website, etc. This information will be presented ONLY in the Basic sessions and will not be repeated in specific program workshops. All Basic workshop sessions will be identical in content and will only be presented once in each location.
NOTE: We strongly advise all providers who have never attended a Basic workshop, and are new to billing Louisiana Medicaid OR have questions concerning Basic Medicaid policy to attend this workshop.
CommunityCARE WILL BE COVERED IN SEPARATE CommunityCARE WORKSHOPS. CommunityCARE will not be discussed in detail in any other workshops. These workshops will also be identical in content and will cover all aspects of the CommunityCARE Program, including e-RA.
In each specific program workshop, Unisys staff will discuss recent policy or procedure changes for that specific program. Basic information such as eligibility, third party liability, CommunityCARE, etc. WILL NOT be presented in the specific program workshops. Providers are strongly advised to attend the Basic and CommunityCARE workshops to hear details about policy information relating to either of those programs.
**Please carefully review the schedule to see which programs are included at which location since only certain Louisiana Medicaid programs will be presented at each location. Program offerings vary by city.
Providers may attend any of the Basic sessions and any of the CommunityCARE sessions, in addition to their specific program session.
Due to space limitations in all workshops, please limit attendees to two (2) persons per provider. Attendees should arrive 15 - 20 minutes early to register. Remember,
� each person MUST register individually, have his or her provider name and Medicaid provider ID number in order to register and attend, and
� providers are required to have a valid Medicaid provider ID number for each specific program workshop attended.
Medicaid programs for discussion at the workshops include:
1. Basic Medicaid Information: All providers should attend. Basic Medicaid information will be presented as previously detailed.
2. CommunityCARE: All providers should attend. CommunityCARE information will be presented as previously detailed.
3. Eligibility: All providers may attend. Includes Health Literacy/Cultural Competency, LaChip, Medicare Buy-In, and the Medicaid Services Chart.
4. Professional: (Professional services include physicians, APRNs, optometrists, ophthalmologists audiologists, podiatrists, chiropractors, labs and ambulatory surgery centers.) This program will include some general information but will primarily cover policy concerning anesthesia, obstetrics/gynecology, and APRNs.
5. KIDMED: This program is for ALL KidMed providers. KidMed policy and billing will be
discussed.
6. RHC/FQHC: For Rural Health Clinics and Federally Qualified Health Center providers. Policy and billing issues will be discussed.
7. Dental: For EPSDT Dental, Adult Denture, Expanded Dental Services for Pregnant Women (EDSPW), and Oral Surgeons. Dental policy and billing will be discussed.
8. ICF/MR Facilities: This presentation is for ICF/MRs ONLY. Billing for the new I-CAP reimbursement methodology will be discussed.
9. Long Term Care: For Nursing Home providers ONLY. Policy and billing will be discussed.
10. Hospice: For Hospice providers. Hospice policy and billing will be discussed.
11. Non-Emergency Medical Transportation: Non-emergency, non-ambulance providers only--does not include ambulance transportation. NEMT policy and billing will be discussed
12. Hemodialysis: This program is for free-standing hemodialysis centers ONLY. Hemodialysis policy and billing will be discussed.
13. Vision: For optical suppliers, optometrists and ophthalmologists. Vision policy and billing will be discussed.
14. Hospital: Acute, Rehabilitation, Long Term, Free-standing Psych and Distinct Part Psych Hospitals. Hospital policy and billing issues will be discussed.
15. Waiver: All waiver providers should attend. Waiver policy and billing will be discussed. PCS services will be presented in the PCS workshop.
16. PCS (EPSDT and Long Term): All EPSDT PCS and Long Term PCS providers should attend. PCS policy and billing will be discussed.
17. EPSDT Health Services (School Boards and Early Intervention Centers ONLY): EPSDT Health Services policy and billing will be discussed. EPSDT PCS services will be discussed in the PCS workshop.
No Pharmacy workshops will be presented during these sessions. Pharmacy workshops were held in June 2004.
Workshops will not be held at this time for: Home Health, DME, Ambulance, Free Standing Rehabilitation Centers, Mental Health Rehabilitation and Mental Health Clinics
Please refer to the workshop schedule for dates (Day 1 and Day 2) and times for each workshop location. Note that there may be more than one session held at the same time. There is no pre-registration required. Please direct any questions concerning the workshops to Unisys Provider Relations at 800/473-2783 or 225/924-5040. Meeting sites should be contacted for directions or sleeping accommodations ONLY! DO NOT contact the meeting sites with questions related to the workshops!
|
CITY
|
DAY, DATE, TIME, AND SESSION
|
Baton
Rouge
|
Tuesday,
October 19
|
Wednesday,
October 20
|
Room
Name
|
Auditorium
|
Classroom
|
Auditorium
|
Classroom
|
|
LA
State Police Training Academy/Building A
7901
Independence Blvd
Baton
Rouge, LA
|
8:30
� 10:30 - Hospital
10:45-12:15
� Dental
1:30-3:00
- Waiver
3:15
� 5:15 - CommunityCARE
|
8:30-9:30
� EPSDT Health Services
9:45-11:15
� RHC/FQHC
11:30-1:00
- PCS
2:30-3:30
- Hemodialysis
3:45-4:45
- Hospice
5:30-6:30
- NEMT
|
8:00-10:30
� Professional
10:45-12:15
� KidMed
12:30-3:00
- Basic
3:15-5:15
� CommunityCARE
|
8:00-10:00
� Long Term Care/Nursing Facilities
10:15-12:15
� ICF/MR
1:30-2:45
� Eligibility
3:15-4:45
- Vision
|
|
New
Orleans
|
Thursday,
October 21
|
Friday,
October 22
|
Room
Name
|
Rivertown
1,2 and 3
|
Rivertown
1, 2 and 3
|
|
Ponchartrain
Center
4545
Williams Blvd
Kenner,
La 70065
|
8:30
� 10:30 - Hospital
10:45-12:15
� Dental
1:30-3:00
- Waiver
3:15
� 5:15 - CommunityCARE
|
8:30-9:30
� EPSDT Health Services
9:45-11:15
� RHC/FQHC
11:30-1:00
- PCS
2:30-3:30
- Hemodialysis
3:45-4:45
- Hospice
5:30-6:30
- NEMT
|
8:00-10:30
� Professional
10:45-12:15
� KidMed
12:30-3:00
- Basic
3:15-5:15
� CommunityCARE
|
8:00-10:00
� Long Term Care/Nursing Facilities
10:15-12:15
� ICF/MR
1:30-2:45
� Eligibility
3:15-4:45
- Vision
|
|
Alexandria
|
Monday,
October 25
|
Tuesday,
October 26
|
Room
Name
|
|
|
|
Best
Western Inn- Suites & Conference Center
2720
West MacArthur Dr
Alexandria,
LA
|
8:30-10:30
� Hospital
10:45-12:45
� CommunityCARE
1:30-2:45
� Eligibility
3:00-5:00
� ICF/MR
|
8:00-10:30
� Professional
10:45-12:15
� RHC/FQHC
12:30-3:00
� Basic
3:15-5:15
- CommunityCARE
|
|
Bossier City
|
Wednesday,
October 27
|
Thursday,
October 28
|
|
Room Name
|
Main
Hall
|
Main
Hall
|
Main
Hall
|
Main
Hall
|
|
Bossier
Civic Center
620
Benton Road
Bossier
City, La
71111
|
8:30
� 10:30 - Hospital
10:45-12:15
� Dental
1:30-3:00
- Waiver
3:15
� 5:15 - CommunityCARE
|
8:30-9:30
� EPSDT Health Services
9:45-11:15
� RHC/FQHC
11:30-1:00
- PCS
2:30-3:30
- Hemodialysis
3:45-4:45
- Hospice
5:30-6:30
- NEMT
|
8:00-10:30
� Professional
10:45-12:15
� KidMed
12:30-3:00
- Basic
3:15-5:15
� CommunityCARE
|
8:00-10:00
� Long Term Care/Nursing Facilities
10:15-12:15
� ICF/MR
1:30-2:45
� Eligibility
3:15-4:45
- Vision
|
|
Houma
|
Wednesday,
November 3
|
|
|
Houma-Terrebonne
Civic Center
346
Civic Center Blvd
Houma,
LA
|
8:30-11:00
- Professional
11:15-1:15
� CommunityCARE
2:00-4:30
� Basic
|
|
Lake
Charles
|
Monday,
November 8
|
Tuesday,
November 9
|
Room
Name
|
Exhibition
Hall
|
Exhibition
Hall
|
|
Lake
Charles Civic Center
900
Lakeshore Dr
Lake
Charles, LA
|
8:30-10:30
� Hospital
10:45-12:45
� CommunityCARE
1:30-2:45
� Eligibility
3:00-5:00
� ICF/MR
|
8:00-10:30
� Professional
10:45-12:15
� RHC/FQHC
12:30-3:00
� Basic
3:15-5:15
- CommunityCARE
|
|
Lafayette
|
Wednesday,
November 10
|
Thursday,
November 11
|
|
Room
Name
|
Pink
Perfection
|
Purple
Dawn
|
Pink
Perfection
|
Purple
Dawn
|
|
Holiday
Inn Holidome
2032
N Evangeline Thruway
Lafayette,
La 70509
|
8:30
� 10:30 - Hospital
10:45-12:15
� Dental
1:30-3:00
- Waiver
3:15
� 5:15 - CommunityCARE
|
8:30-9:30
� EPSDT Health Services
9:45-11:15
� RHC/FQHC
11:30-1:00
- PCS
2:30-3:30
- Hemodialysis
3:45-4:45
- Hospice
5:30-6:30
- NEMT
|
8:00-10:30
� Professional
10:45-12:15
� KidMed
12:30-3:00
- Basic
3:15-5:15
� CommunityCARE
|
8:00-10:00
� Long Term Care/Nursing Facilities
10:15-12:15
� ICF/MR
1:30-2:45
� Eligibility
3:15-4:45
- Vision
|
Monroe
|
Tuesday,
November 16
|
Wednesday,
November 17
|
|
Room
Name
|
Ballroom
|
Ballroom
|
Ballroom
|
|
Holiday
Inn Holidome
1051
Hwy 165 Bypass
Monroe,
LA
|
8:30-10:30
� Hospital
10:45-12:30
� RHC/FQHC
2:00-4:00
- CommunityCARE
|
8:30-10:30
� ICF/MR
10:45-12:15
� Long Term Care/Nursing Facilities
12:30-1:45
- Eligibility
|
8:30-10:30
� Professional
10:45-12:45
� CommunityCARE
2:00-4:30
- Basic
|