As of January 12, 2017, the New York City health code now requires additional reporting for children less than five years of age with a positive test for TB infection (e.g., interferon gamma release assay [IGRA] or tuberculin skin test [TST]), including documentation of subsequent evaluation to rule out TB disease. An up-to-date version of the Health Code (§11.21) can be found at https://www1.nyc.gov/site/doh/about/about-doh/health-code-and-rules.page.
MEIPASS (Medicaid EHR Incentive Program) is now open for meaningful use (MU) attestations. Please note that the MU attestation is hybrid as it is comprised of two parts.
- Attest in MEIPASS
- Complete the Meaningful Use Workbook
The deadline for 2015 MU is 6/30/2017.
The deadline for 2016 MU is 9/15/2017.
Visit MEIPASS to begin your MU attestation.
Ordering/Prescribing/Referring (OPR) Providers Must Revalidate for Claims to be Paid
Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years. For many providers Medicaid payment is contingent on the ordering/prescribing/referring (OPR) provider also revalidating their enrollment in Medicaid. OPR providers who do not comply with the revalidation requirement will be terminated from the Medicaid Program.
The NYS Department of Health has determined that many providers are at risk for not being paid for their services because the OPR provider has not complied with the revalidation requirement. Because this has the potential to result in significant non-payable claims for you/your facility, we urge you to reach out and encourage your OPR providers to revalidate their enrollment. Please remember to confirm that your OPR provider is enrolled before rendering service at: www.emedny.org/info/opra.aspx.
- The Claim Adjustment Reason Code for non-enrolled OPR provider on your 835 remittance will be: B7 – This Provider was Not Certified/Eligible to be Paid For this Procedure/Service on this Date of Service.
- If performing a claim status look for Claim Status Code 91 with Entity Code 1P.
The required revalidation form and instructions are available at https://www.emedny.org/info/
Health Barriers to Learning: The Prevalence and Educational Consequences in Disadvantaged Children – https://www.childrenshealthfund.org/hbl-literature-review/ describes the HBLs and the supporting evidence base for their impact on academic success. It also describes the disproportionate prevalence of HBLs in disadvantaged children, the extent of unmet need for services for identification, management and treatment, and each HBL’s impact on learning. The report offers recommendations for better identification, management, and treatment of these barriers.
Champion E-Correspondence, September 2016 – from the AAP’s Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis
Champion E-Correspondence, August 2015 – from the AAP’s Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis
Practice Management Resources
Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics and supported by the Maternal and Child Health Bureau, Health Resources and Services Administration. The Bright Futures Guidelines provide theory-based and evidence-driven guidance for all preventive care screenings and well-child visits. Bright Futures content can be incorporated into many public health programs such as home visiting, child care, school-based health clinics, and many others. Materials developed especially for families are also available.
The National Center for Medical Home Implementation (NCMHI), a cooperative agreement between the American Academy of Pediatrics (AAP) and the Maternal and Child Health Bureau of the Health Resources and Services Administration, published two new resources that may be of interest to AAP Chapter members:
- State Pediatric Medicaid and CHIP Medical Homes Initiatives: At-a-Glance Table
The National Center for Medical Home Implementation, in partnership with the National Academy for State Health Policy, recently updated its “State at-a-glance” table. The table provides an overview of publicly funded state programs that support the implementation and spread of the pediatric medical home model of care, including information on Health Home State Plan Amendments, and states that have active Medicaid payment for pediatric medical home programs.
- Language Access in Primary Care
Created in partnership with the National Center for Cultural Competence, this article provides examples of language access services and strategies to enhance language access services in pediatric primary care practices.
AAP Reimbursement Initiatives
Updates on AAP initiatives related to private payer advocacy will be posted here on a regular basis.
Effective January 1, 2015, the CPT code for fluoride varnish application is 99188. It is suggested to append a V-33 modifier for preventive services.
PPAAC has learned from our Aetna contact that Aetna will not be covering HPV9 for boys greater than 15 years of age and if submitted claims will not be paid for that age group. This is despite the ACIP recommendation and the recent AAP News publication that we shared with them. Aetna revisits these policies quarterly. This will stand at least until the fall of 2015.
Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis E-Correspondence, June, 2015.
The National Center for Medical Home Implementation (NCMHI) in the American Academy of Pediatrics (AAP) is pleased to announce the launch of its new and improved Web site, www.medicalhomeinfo.org.
The Web site provides pediatric medical home information, tools, and resources for practices and clinicians, specifically pediatricians. Visit the Web site to learn about the following:
- Education and training opportunities
- Tools and resources for pediatric medical home implementation
- Evidence supporting the pediatric medical home model
- Information about pediatric medical home initiatives in 50 states and the District of Columbia