Friday, October 17, 2014 Headlines

News and information for LTC providers.
Friday, October 17, 2014 Headlines
Ebola has hit a little closer to home. Please note the articles on Ebola,
including protocols you may want to follow.
Ohio News
1. ODH releases hospital protocols for Ebola;
SNFs/RCFs recommended to follow
2. Update on current Ebola actions in Ohio
3. MyCare Ohio: Claims processing and procedures
4. MyCare Ohio: AL services management; Aetna,
Buckeye transportation updates
Federal News
5. MLN newsletter
1. ODH releases hospital protocols for Ebola; SNFs/RCFs recommended to
The Ohio Department of Health, via the EIDC system, sent the following message to all nursing homes and
residential care facilities yesterday:
TO: Nursing Homes and Residential Care Facilities
For your information, attached are documents sent to Ohio Hospitals. The Department suggests adapting these
documents for use in your facility. The attachments were as follows:
Ebola Drill for Hospitals
Ebola Guidance
Letter to Hospital CEOs
Detailed Hospital Checklists
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2. Update on current Ebola actions in Ohio
The Ohio Department of Health (ODH) continues to work with interested parties on keeping them update on current
activities related to the Ebola virus. Yesterday, they notified The Academy that the CDC, ODH and Summit County
Health Department are seeking to identify any customers who may have visited the Coming Attractions Bridal Salon,
1220 E. Tallmadge Ave., Akron, 44310 on Sat., October 11, between 12 and 3:30p. Anyone who visited the store
then should call 330-926-3939. They also released recommendations for hospitals and a hotline for the general
public. More specifically:
The Ohio Department of Health has recommended hospital again conduct a round of Ebola preparedness drills with
their frontline health care workers. Read more here:
Ohio issued enhanced recommendations for quarantine protocols. Read more here:
Ohioans who have questions about Ebola can call the Ohio Department of Health’s 24/7 hotline at 1-866-800-1404.
More information is here:
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3. MyCare Ohio: Claims processing and procedures
The latest news and information from MyCare Ohio plans on claims processing and procedures:
Lump Sum vs Patient Liability: Aetna, CareSource, Molina and UHC, lump sum use value code 31 and patient
liability in Box 54; Buckeye, SNFs submitting lump sum claims need to call Provider Services at 866/2966-8731.
Correction of Incorrect Rates/Payments: The plans all have the July rates loaded and are in the process of
reconciling any claims that have been paid incorrectly with the exception of UHC. Each plan is in a different stage of
the process, but should be finished within the next month. We continue to work with the plans on putting together a
spreadsheet regarding incorrect payments because of patient liability. Providers can continue to request claims
reconciliation or reconsideration for claims when the patient liability is incorrect. Molina is still not using patient liability
when processing claims and is testing their systems this week. If your Buckeye claims are processing with the
incorrect decimal point, Buckeye recommends adding two 00 without the decimal point for their patient liability
amounts (example; $100 reported as 10000). Molina and Buckeye will correct claims that have been paid incorrectly.
Crossovers/Coinsurance: More errors and issues around coinsurance are starting to be noticed. Aetna said their
problems may be occurring because they had the edit turned off at the beginning and it is now on. UHC is also
seeing some crossovers being paid at 100%. The plans would like examples of crossover claims that have been paid
in error. Please contact The Academy if you are having issues with crossover claims.
MDS Assessments: For fully enrolled MyCare beneficiaries (both Medicare and Medicaid benefits), only OBRA
assessments can be sent to CMS, not the "PPS" part of a dual assessment. Concerns have been raised about
individuals switching between FFS and MyCare. While uncertainty still exists about the process of switching payers, it
is recommended that all assessments should be done while on MyCare and to carry forward after the switch to FFS.
There is also concern over an allowable stay because of the 3-day hospital requirement for FFS if the switch occurs
after 30 days.
PA1/PA2: Plans are still having issues processing PA1/PA2 claims. It may be an issue of revenue code 0220 not
going through the clearinghouse. Providers may need to contact their clearinghouse to have a special edit put in
place for that revenue code. If that is not the issue, please contact The Academy and let us know.
CHOPS: Providers are reminded to contact the MCOs if they have recently undergone a change of provider. They
will need to provide the MCO with updated information such as the TIN.
EFT: UHC and Aetna do not use the same EFT as their commercial line. You can find Aetna's EFT and ERA application
documents for Aetna Better Health of Ohio here.
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4. MyCare Ohio: AL services management; Aetna, Buckeye transportation
AL Services: MyCare AL services (those tat were provided under the Medicaid AL waiver) continue to cause some
confusion as there are two individuals involved: the service coordinator and the care manager. To start, the AAAs still
need to do an assessment for the AL service if the person has not received AL services in the past. Generally, once
in the system, the service coordinator is responsible for services that were provided under the AL waiver. The care
manager, while overseeing all services, is responsible for non-waiver services. For example, if the person goes to the
hospital, the care manager would need to be notified. Aetna and CareSource delegated care management to the
service coordinator.
Transportation: Aetna and Logisticare will be holding open forums to discuss transportation issues related to
nursing homes. Transportation providers are welcome to attend and they are encouraging you to bring your preferred
providers. The forums are:
Where: Maumee Library; 501 River Rd, Maumee, Ohio 43537
When: October 20, 2014; 10am-12pm OR 2-4pm
Where: Sharonville Convention Center; 11355 Chester Rd, Cincinnati, Ohio 45246
When: October 22, 2014; 10am-12pm OR 2-4pm
Where: Hampton Inn Suites; 4150 Stelzer Rd, Columbus, Ohio 43230
When: October 23, 2014; 10am-12pm OR 2-4pm
Please RSVP to Rachel Mcgrady ([email protected])
On a related note, Buckeye has announced that they will begin using transportation broker MTM on Jan 1. (Back to
5. MLN Newsletter
MLN Newsletter for Thursday, October 16, 2014
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