Medicaid Information from CNAP

News from Medicaid

All APRNs who are Medicaid providers should bookmark the Texas Medicaid Healthcare Partnership (TMHP) provider page to check the new banner messages that inform Medicaid providers about changes and corrections in the Texas Medicaid Program. Those messages often involve new procedure or diagnostic codes that will or will not be reimbursed and other provider information that may apply to APRNs.

Action Required by All Medicaid Providers

By October 30, 2011, all APRNs who are Medicaid providers must attest to the primary taxonomy code that best describes their practice. These are the same codes that providers declare when applying for a National Provider Identifier (NPI), but taxonomy codes are updated 2 times each year by the National Uniform Claim Committee (NUCC) and taxonomy codes should be consistent with the most recent codes effective on October 1, 2011.

Policy staff at the Texas Health & Human Services Commission (HHSC) advises each APRN enrolled in Medicaid to designate the code that most closely aligns with the advanced practice role and population focus area recognized for that APRN by the Texas Board of Nursing. APRNs recognized in more than one role and population focus area may designate more than one code, and those APRNs practicing in specialties may also designate additional specialties, as long as they are specialty areas attached to advanced practice nursing roles. However, the Provider Information Change (PIC) form used to submit the identifier only asks for the Primary Taxonomy Code.

CNAP advises all APRNs enrolled as Medicaid providers to take the following action.

1. If you are a CNS or NP, read the HHSC advisory to NPs and CNSs that includes a list of CNS and NP taxonomy codes. Identify the code that aligns most closely with the APRN role and population focus recognized by the Texas Board of Nursing and under which you provide Medicaid services. For CRNAs, the current taxonomy code should be 367500000X. For CNMs, the taxonomy code is 367A00000X.

2. Check your taxonomy codes currently on record. Go to any provider page on the TMHP Website, click “Log in to My Account” in the upper right corner, select “Provider Information Management System” (PIMS). Your primary taxonomy code appears at the top of the page.

3. If the taxonomy code does not currently reflect the broadest code most appropriate to your practice, submit a Provider Information Change (PIC) Form. Download the PIC form and include the updated taxonomy code in the cell labeled “Primary Taxonomy Code”. Also include the nine-digit Texas Provider Identifier (TPI) and corresponding National Provider Identifier (NPI), your signature and date. Any form that does not include all of these will be returned to the provider.

Mail or fax the completed PIC form to:

Texas Medicaid & Healthcare Partnership (TMHP)

Provider Enrollment

PO Box 200795

Austin, TX 78720-0795

Fax: 512-514-4214

REMEMBER THIS MUST BE DONE BY OCTOBER 30, 2011, OR YOU WILL BE ASSIGNED A DEFAULT PROVIDER CODE THAT MAY NOT BE THE MOST APPROPRIATE CODE FOR YOU.

Additional information on provider taxonomy codes is available. The explanation for taxonomy codes by CMS appears at http://www.cms.gov/MedicareProviderSupEnroll/08_Taxonomy.asp. The complete list of taxonomies published by the National Uniform Claim Committee is available at http://www.nucc.org/index.php?option=com_wrapper&Itemid=50.

Delivery Codes Must Reflect Medical Necessity

The Medicaid program now requires a modifier attached to each obstetric delivery procedure code. The modifier U1 indicates a medically necessary delivery prior to 39 weeks; U2 indicates a delivery at 39 weeks gestation or later; and U3 indicates a non-medically indicated delivery prior to 39 weeks.

For dates of service on or after October 1, 2011, the Texas Medicaid Program will no longer reimburse health care practitioners or hospitals for inductions or cesarean sections performed before 39 weeks gestation unless those procedures are medically necessary. Therefore, claims for obstetric delivery procedure codes accompanied by the U3 modifier will not be reimbursed. For additional information, see the HHSC notices, “Update to Claims for Obstetric Deliveries to Require a Modifier” and “Hospital Claims for Obstetric Deliveries”.

APRNs may Sign Therapy Orders for Children under 21 Years

Some Good News: Effective June 3, 2011, APRNs may sign all documentation authorizing private duty nursing (PDN) and therapy (OT, PT & ST) services provided through the Comprehensive Care Program (CCP) for Texas Health Step-eligible clients age 20 or younger. While the TMHP announcement does not explicitly state this, HHSC policy staff confirmed this authorization to sign therapy and PDN forms includes services provided through the Early Childhood Intervention (ECI) program and Medicaid managed care plans.

Some Bad News: This is another delegated medical act. HHSC is permitting APRNs and PAs to sign the documentation on behalf of the “client’s physician”. Therefore, if you care for children on Medicaid who require home care, discuss this with your delegating physician. If the physician agrees you should sign the forms, include this in your prescriptive authority protocol. As with any change in the protocols occuring prior to the usual annual review, both you and the physician should initial and date the change.

Warn Your Medicaid Clients about this Scam

HHSC advised Medicaid providers and clients on October 11, 2011, about an illegal ploy to obtain bank account information from Medicaid recipients pretending to charge the recipient for a replacement Medicaid benefits card. HHSC asks your help to advise Medicaid clients not to give any personal information to callers. Medicaid replaces any lost “Your Texas Benefits Medicaid” card free of charge and responds to requests for replacements by mail. Click Here to read the original notice from HHSC.

 Signing Medical Verifications for Permanent & Temporary Disabled Parking Placards

Interim Update #2 issued on September 1, noted that APRNs may now sign the portion of the disabled parking placard application that verifies the patient meets the criteria specified on the form. At that time, I indicated this authority only included signing for temporary parking placards. Since then Carol Vaughan, FNP, started checking the law and asked me to do the same. Sure enough, while §681.003, Transportation Code, only allows APRNs and PAs to sign the initial application for parking placards, the statute does not distinguish between temporary and permanent parking placards. Therefore, APRNs and PAs may verify that a disability is either temporary or permanent on the initial application.

Once again, this is a delegated medical act and should be included in your protocol if your delegating physician agrees you should sign these applications. Carol found some helpful links on the Department of Motor Vehicles website. Registration and Title Bulletin #028-11 to all County Tax Assessor-Collectors confirms that PAs and APRNs may sign Form VTR-214, “Application for Persons with Disabilities Parking Placard and/or License Plate.” Please note that the signature line on the form still states “Physician*, Podiatrist, or Optometrist,” but the asterisk at the top of the page notes “physician” includes PAs and APRNs.

You may wish to bookmark the newly updated article on CNAP’s Website, “Disabled Parking: What APRNs Need to Know.”