El Paso Health | About Your Health | Winter 2019

Provider Newsletter 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 1-877-532-3778 101926EPH121718–Winter 2019 Provider Newsletter 2019 © Coffey Communications, Inc. All rights reserved. Fraud: An intentional act of deception, misrepresentation, or concealment in order to gain something of value. Examples include: ■  ■ Billing for services that were never rendered. ■  ■ Billing for services at a higher rate than is actually justified. ■  ■ Deliberately misrepresenting services, resulting in unnecessary costs to the Health Plan, improper payments to providers, or over-payments. Waste: Over-utilization of services and the misuse of resources. Abuse: Excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice. Refers to incidents that, although not fraudulent, may directly or indirectly cause financial loss. Examples include: ■  ■ Providing medically unnecessary services. ■  ■ Billing for items or services that should not be paid for by Medicaid. You can help fight fraud and abuse in the Medicaid system Knowing and following these tips improves billing; helps fight fraud, waste, and abuse; and helps strengthen the integrity of the Medicaid program: ■  ■ Check Medicaid patient eligibility on a regular basis. ■  ■ Bill only for covered services provided to eligible beneficiaries. ■  ■ Document, authorize, and justify the medical need for services provided. ■  ■ Do not sign blank medical services documents. ■  ■ Do not unbundle or upcode services. ■  ■ Do not order unnecessary services. REPORT TO: ■  ■ El Paso Health Fraud Hotline 1-866-356-8395 ■  ■ Office of Inspector General at 1-800-436-6184 or oig.hhsc.state.tx.us/OIGPortal Program for children of traveling farmworkers El Paso Health has special Medicaid ser vices for the children of traveling farmworkers. The ser vices include assistance with scheduling their upcoming Texas Health Steps Exams as well as 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 traveling farmworkers or would like for the program coordinator to provide an in-ser vice to your staff, please call the Outreach Coordinator at 915-532-3778, ext. 1075 . What is fraud, waste, and abuse? ■  ■ Contact the State Medicaid /MCO agency if you discover incorrectly billed claims. How to report suspected fraud and abuse If you suspect fraud and abuse, there are several reporting options available to you. All reports are confidential and can be anonymous, if you choose. You are not required to include your name, address, or other identifying information. Source: cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity- Education/Downloads/key-messages-Common-Types-Fraud-Abuse-[May-2016].pdf stay informed