Provider Training Sessions

Please plan to attend a Training Session for "Navigating the Public Mental Health System" at one of various sites throughout the State during the month of June. The seminars are free and we think that all will benefit from a refresher on Billing, Compliance, and Authorization Procedures. Specific training sessions are as follows:

• June 10 Spring Grove Hospital Center, Catonsville
• June 13 Allegany County Health Department, Cumberland
• June 16 Crownsville Hospital Center, Crownsville
• June 26 Charles County Dept. of Social Services, La Plata
• June 30 Eastern Shore Hospital Center, Cambridge

Go to the Training Section for the Application Form, Agenda, and Driving Instructions.

Claims Update

Billing for ER Services on UB-92

Please remember the following when billing ER Services to the Public Mental Health program.

• Revenue Code 450, ER, General-Billable
• Revenue Code 451, ER Medical Screening (EMTALA)-Billable
• Revenue Code 452, ER Services Beyond EMTALA-NOT BILLABLE

Only one unit of either Revenue Code 450 or 451 is payable on the same claim.

One Day Hospital Stays

Providers should submit claims with one-day hospital stays (no overnight) via paper, not electronic. The UB-92 should be completed as follows:

Example

Block 6 From: 4-11-03 Through: 4-11-03
Block 32 Code: 42 Occurrence: 4-11-03

6T Pend Code

Several providers have questioned claims listed on their EOPs with a payment of $0 and a pend code of 6T. Please do not be alarmed. The 6T pend is merely an indicator to the provider that the claims have been received at MAPS-MD and are awaiting processing while internal system checks or research is being performed. Typically, adjudication of the claims will occur on the next or subsequent EOP with either payment or denial of the claim being reported. The 6T pend is informational only. You do not need to call or inquire about the pend or lack of payment on the EOP, since at that point the claim has not adjudicated.

Authorizations

Claims Denials

The MAPS-MD claims system denies many claims because it cannot find an authorization for the service. Frequently, the problem is that the authorization was not issued to the appropriate provider number, so a match is not being made between the claim and the authorization. Please remember to identify the correct Medical Assistance Number when requesting an authorization. If the rendering provider is a member of a group, please use the group number. If your organization uses multiple numbers, please make certain that the number for the organization that will be billing is used.

Treatment Plans

If your facility is enrolled in the fax authorization program, please program your fax machine to display your fax number on outgoing faxes. This speeds up the research of the Treatment Plan unit when researching missing treatment plans. Thank you for your assistance!

Fax Authorization Program

If you are not enrolled in the fax authorization program and would like to be, please send an email to info@gzmd.com.

HIPAA

Business Associate Agreements

MAPS-MD has received several requests from providers to sign Business Associate agreements pursuant to HIPAA. MAPS-MD is not signing Business Associate agreements if the relationship between the provider and MAPS-MD falls within the exceptions outlined in guidance from the U.S. Department of Health and Human Services, as set forth below:

Excerpt from the Health and Human Services Office of Civil Rights Guidance issued on December 2, 2002:

Exceptions to the Business Associate Standard. The Privacy Rule includes the following exceptions to the business associate standard. See 45 CFR 164.502(e). In these situations, a covered entity is not required to have a business associate contract or other written agreement in place before protected health information may be disclosed to the person or entity.

Disclosures by a covered entity to a health care provider for treatment of the individual. For example:

• A hospital is not required to have a business associate contract with the specialist to whom it refers a patient and transmits the patient's medical chart for treatment purposes.
• A physician is not required to have a business associate contract with a laboratory as a condition of disclosing protected health information for the treatment of an individual.
• A hospital laboratory is not required to have a business associate contract to disclose protected health information to a reference laboratory for treatment of the individual.

Other Situations in Which a Business Associate Contract Is NOT Required

When a health care provider discloses protected health information to a health plan for payment purposes, or when the health care provider simply accepts a discounted rate to participate in the health plan's network. A provider that submits a claim to a health plan and a health plan that assesses and pays the claim are each acting on its own behalf as a covered entity, and not as the "business associate" of the other.

Software Testing

Reminder: Please check with your billing software vendor to make certain that you will meet the October 16, 2003 deadline for HIPAA compliant electronic transactions.

Waivers

The Maryland Budget Bill for FY 2004 includes the following language:

…the Mental Hygiene Administration may not waive payment regulations in effect April 1, 2003, except as specifically authorized in legislation.

This means that the Mental Hygiene Administration does not have the legal authority to waive any payment regulations currently in effect except for those cases as discussed in the February 2003 MAPS-MD Issues Bulletin. Excerpts of the regulations regarding timeliness are reprinted below:

Waivers of Pre-authorization and Timely Filing Requirements

Unless, the Provider proves that failure to meet the requirements stated below was solely due to actions by MHA/MAPS-MD or its agents, pre-authorization and timely filing requirements will not be waived.

COMAR 10.09.36.06 states: The Department may not reimburse the claims received by the Program for payment more than 9 months after the date of service.

A claim for services provided on different dates and submitted on a single form shall be paid only if the Program receives it within 9 months of the earliest date of service.

A claim which is rejected for payment due to improper completion or incomplete information shall be paid only if it is properly completed, resubmitted, and received by the Program within the original 9 month period, or within 60 days of rejection, whichever is later.

Claims submitted after the time limitations because of a retroactive eligibility determination shall be considered for payment if received by the Program within 9 months of the date on which eligibility was determined.

COMAR 10.09.59.06 Provides that a provider shall comply with the preauthorization requirements of 10.09.70.07.

Previous Issues of the Bulletin