El Paso Health | About Your Health | Fall 2018

Provider Newsletter resources ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 877-532-3778 , elpasohealth.com . Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 877-532-3778 . Models may be used in photos and illustrations. Member Services 877-532-3778 10197EPH091418–Fall 2018 Provider Newsletter 2018 © Coffey Communications, Inc. All rights reserved. El Paso Health has special Medicaid services for the children of traveling farmworkers. El Paso Health assists members in scheduling their Texas Health Steps medical checkup appointments before they travel with their parents to work on the fields. We also have vision, mental health, and transportation benefits for them. If you have any questions or would like to receive more information about these services for children of agricultural workers, please call the Outreach Coordinator at 915-532-3778, ext. 1075 . Program for children of traveling farmworkers Accurate coding and billing P ayers and patients trust you to provide medically necessary, cost-effective, high-quality care. You exert significant influence over what services your patients receive. You control the documentation describing what services they actually received, and your documentation serves as the basis for claims sent to insurers for services provided. Generally, the Medicaid program pays claims based solely on representations in the claims documents. When you submit a claim for services performed for a Medicaid patient, you are filing and certifying that you earned the payment requested and complied with the billing requirements. If you knew or should have known the submitted claim was false, then the attempt to collect payment is illegal. Examples of improper claims include: ■  ■ Billing for medically unnecessary services. ■  ■ Billing for services not provided. ■  ■ Billing for services performed by an improperly supervised or unqualified employee. ■  ■ Billing for services performed by an employee excluded from participation in the Federal health-care programs. ■  ■ Billing for services of such low quality that they are virtually worthless. ■  ■ Billing separately for services already included in a global fee, like billing for an evaluation and management service the day after surgery. Physician documentation Maintain accurate and complete medical records and documentation of the services you provide, and ensure your documentation supports submitted claims for payment. Good documentation ensures your patients receive appropriate care from you and other Providers who may rely on your records for patients’ medical histories. The Medicaid Program may review members’ medical records. Good documentation helps address any challenges raised about the integrity of your claims. You may have heard the saying regarding malpractice litigation: “If you didn’t document it, it’s the same as if you didn’t do it.” The same can be said for Medicaid billing. If you have reason to believe that someone is defrauding the Medicaid program or abusing a Medicaid recipient, contact the Medicaid Fraud Control Unit headquarters in Austin or 1 of the field offices listed below. ■  ■ El Paso Health Hotline: 1-866-356-8395 . ■  ■ Or visit the Office of Inspector General’s website at: https://oig.hhs.gov/fraud/ report-fraud/index.asp . ■  ■ Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477) . ■  ■ cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/ MLNProducts/Downloads/Avoiding_ Medicare_FandA_Physicians_ FactSheet_905645.pdf .