2015 Wyoming Medicaid Medical and Institutional Workshops

1. 2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager ShereeNall – Provider Services Manager Sara Rogers – Facilities Manager Brenda Stout – Behavioral Health Manager

2. Session Topics: • Introductions • Medicaid Decision Making • WY Medicaid ICD-10 Project • Upcoming Program Changes • Chiropractic • Mental Health Provisional Providers

3. Program Managers • Amy Buxton – Ambulance, DME, Hearing and Audiology, Lab and Radiology, PT/OT/ST, Client Transportation • Sheree Nall – Physician and Nurse Practitioner Services, Indian Health Services, ASC, Health Homes, Family Planning Waiver, Public Health Nurses • Sara Rogers – Hospitals, ESRD, Nursing Home, RHC/FQHC, PRTF, CORF • Brenda Stout – CMHC/SATC and Mental Health Services

4. Medicaid Decision Making Process • Code of Federal Regulations (CFR) • Title 42 – Public Health • http://www.ecfr.gov/cgi-bin/ECFR?page=browse • Wyoming State Statutes • Title 42 – Welfare – Wyoming Medical Assistance and Services Act • http://legisweb.state.wy.us/statutes/statutes.aspx

5. Wyoming State Rules • Agency: Health, Department of • Program: Medicaid • http://soswy.state.wy.us/rules/ • Wyoming Medicaid State Plan • Approved by Centers for Medicare/Medicaid Services (CMS) • http://legisweb.state.wy.us/statutes/statutes.aspx

6. Wyoming State Legislature • Statutes and Budget • Governor • - Statutes and Budget • Wyoming Medicaid, Division of Healthcare Financing • State Medicaid Agent • Provider Operations Administrator • Program Manager

7. ICD-10 • Coding Specificity • All required digits must be present • Review ICD-10-CM book for required digits • Claims will deny if codes are not complete • Unspecified codes will not be accepted

8. Systems & Interface Testing • Testing • Provider end-to-end testingis in progress – register at www.wyomingicd10.com • Providers will be able to test specific clinical scenarios to evaluate coder competency and/or evaluate claim processing and denial rates for batches of test files submitted • MUST REGISTER TO TEST – all providers are encouraged to register for testing

9. Why Test? • Avoid payment and cash flow interruption • Ensure revenue neutrality – specifically hospital and inpatient level of care payments • Ensure billing process readiness and system capability for interfacing and transmitting ICD-10 claims to Wyoming Medicaid: YOUR BILLING SYSTEM MAY NEED UPGRADES OR ADDITIONAL CONFIGURATION EVEN IF YOUR BILLING STAFF IS PREPARED! • At the conclusion of testing, providers will be provided with a summary of testing action, denial/paid rates, edits that posted and payment variances detected. WHY TEST?

10. Billing after 10/1/2015 will be date of service (DOS) driven: • DOS prior to 10/1/2015 MUST be billed with an ICD-9 diagnosis/surgical procedure code. • DOS 10/1/2015 and after MUST be billed with an ICD-10 diagnosis/surgical procedure code. • Inpatient services that span September 2015 – October 2015 MUST have ICD-10 coding requirements, as the “through” DOS will determine coding requirements.

11. New Programs and Program Changes • Chiropractic • Mental Health Provisional Providers