The Academy of Senior Health Sciences, Inc. (formerly The Ohio Academy of Nursing Homes, Inc.) seeks to provide public education and awareness initiatives to the long-term care community in Ohio. Our membership represents a true cross-section of the skilled nursing facility profession, from small sole proprietorships to larger Ohio-based multi-facility companies, as well as those businesses that service our industry. Through our public education and awareness efforts, the Academy brings the collective influences of the members together into a single voice on vital issues affecting our profession.
Founded in 1966, the Academy then identified one of its core purposes as "To foster a spirit of goodwill among those persons engaged in the nursing home industry, to promote ethical practices in their relationships with each other, their employees, and the general public to the end that all interests may be served fairly..." Though the organization has undergone several transformations over the years, most notably in 2011, its dedication and commitment to Ohio's most frail and elderly remains the same.
| The Academy Weekly Headlines from 2 Weeks Ago|
HB 64: Senate Finance makes few changes to LTCSS
Senate Finance Committee put their mark on H.B. 64 this week. The committee largely left the SNF reimbursement changes made in the House untouched, only adding Allen and Trumbull Counties to peer group 2. It appears RUGs-IV 48, $1.79 quality incentive amount and the new quality measures, effective July 1, 2016, are heading into conference committee. The Senate Committee did reduce the HCBS waiver nursing wage increase from 10 percent to 5 percent. One of the more controversial moves the committee made was to take the state funding for Medicaid expansion and move it out of the Medicaid line item and into its own line item. This puts the funding for Medicaid expansion in fiscal year 2017 into question, when the state has to begin paying a share of the services for that population. The bill is expected to pass out of the Senate next week and then heads to conference committee.
We'll help you get ready for ICD-10 - October is around the corner!
The move to ICD-10 on October 1 is approaching quickly and The Academy wants to make sure you are ready! And while those who wear the scarlet and grey on game day may have visions of another championship dancing in their heads, MDS nurses and other coders are soon to face the ICD-10 switch. But fret not, LTC coders. We are planning a few one-day intensive sessions to help get you ready for the change. There will be one in the Cleveland/Akron area and one for the Cinci/Columbus area, both to be held in August. So stay tuned for details!
MyCare Ohio: Molina provides info on transition of care, PAs in latest bulletin
Molina has provided the following information for all providers in its latest bulletin:
Important notice for providers serving MyCare Ohio members
The transition of care (TOC) period allowed non-participating providers to see patients without a prior authorization (PA) and participating providers to continue to render services in accordance to TOC guidelines. TOC periods expired May 31 for Molina Dual Options MyCare Ohio members in Butler, Warren, Clinton, Hamilton, and Clermont counties; and June 30 for Clark, Montgomery, Greene, Union, Delaware, Madison, Franklin and Pickaway counties. At that time, providers must have PAs in place if they are out-of-network for all services. All state plan or Medicare-covered services will still need to go through the standard PA process. Click here to access the MyCare Ohio authorization form at MolinaHealthcare.com. The PA Codified List, a full list of services that require PA, is also posted to our website at MolinaHealthcare.com TOC for out-of-network behavioral health providers is extended to Dec. 31, 2015. [ACADEMY NOTE: TOC for individuals in a SNF receiving Medicaid primary payer services at the time of his or her enrollment into MyCare is for the life of the demonstration project. This only applies to non-par providers.]
Attention: Waiver Providers
Molina Healthcare is not requiring any waiver service provider to submit a PA for waiver services. They are considered approved when the Care Manager issues the waiver service plan. If you have questions regarding services under the waiver service plan, you should contact the member's Care Manager directly.
Corrected Claims Submission
Submit corrected claims when changing or adding information, such as a primary EOB or a coding change. Here's how to submit electronic data interchange (EDI) claims corrections.
Web Portal Submission
- Log in with your username and password
- Select "Create a professional claim" from the menu
- Select the radio button for the correct claim option
- Enter the ID number of the claim you want to correct
- Make corrections and add supporting documents (EOB)
- Submit your claim
- In the 2300 Loop, the CLM segment (claim information), CLM05-3 (claim frequency type code) must indicate one of the following qualifier codes:
"7" - REPLACEMENT (replacement of prior claim)
"8" - VOID (void/cancel of prior claim)
- The 2300 Loop, the REF segment (claim information), must include the original claim number issued to the claim being corrected, found on the remittance advice.
- Corrected claim bill type for UB claims are billed in loop 2300/CLM05-1
In Bill Type for UB the 7 or 8 goes in the third digit for "frequency". To learn more, see the Claim Submission Training Guide.
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