El Paso Health | About Your Health | Winter 2018

1. Billing for services not rendered. Make sure your documentation is up-to-date and dates are noted on the progress notes. Document a way to confirm that patient was seen; for example a sign-in sheet or signed documents on that date of service. 2. Billing for a non-covered service as a covered service. Know what services are covered by the health plan before you submit claims. 3. Misrepresenting dates of service. Make sure you are not providing services separately so you get reimbursed for two separate services. 4. Misrepresenting locations of service. For example, avoid giving the member syringes of medication administered at home, then billing for those medications as if they were administered at the provider’s office. 5. Misrepresenting provider of service. Make sure that the provider is on the premises before signing any documentation. 6. Unbundling procedures. Make sure you are familiar with bundled procedures and guidelines. 7. Overutilization of services. Bill only for services that are medically necessary. 8. Corruption (kickbacks and bribery). Avoid any schemes where the provider pays or receives something of value in return for referrals. 9. False or unnecessary issuance of prescription drugs. Prescribe only necessary prescription drugs. 9 forms of waste, fraud, and abuse IF YOU SUSPECT FRAUD OR ABUSE, please report them by calling the numbers below. All reports are confidential and can be anonymous, if you choose. Report to: ■ El Paso Health Hotline: 866-356-8395 ■ Office of the Inspector General: 800-436-6184 Children of agricultural workers who work in the fields present a greater risk of injury than adults because of their lack of experience. An estimated 100,000 children suffer agriculture-related injuries annually in the United States. It has also been found that minors who work in the fields suffer a higher frequency of severe and disabling injuries than those who work in all other occupations. Because child care facilities are rarely Program for children of traveling farmworkers available, many children of farmworkers are present in the fields, exposing them to pesticides on plants and in the dirt. Some studies indicate that pesticide exposure may be harder on children. El Paso Health has special Medicaid services for children of traveling farmworkers. A farmworker is a person who works on farms, in the fields, or as food packer during certain times of the year. They move to different places to follow the crops. El Paso Health assists members in scheduling their Texas Health Steps medical checkup appointments before they migrate with their parents to work in 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 farmworkers, please call the Outreach Coordinator at 915-532-3778, ext. 1075 . Source: National Center for Farmworker Health, Inc. 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 10194EPH121317-Winter 2018 Provider Newsletter 2018 © Coffey Communications, Inc. All rights reserved. resources Provider Newsletter