Provider Newsletter Winter • 2024 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Yakima, WA Permit No. 157 Be ready for 2024 coding changes It’s time to incorporate the 2024 coding changes. Effective Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) announced 395 new diagnosis codes, 25 deletions, and 13 revisions for fiscal year 2024 in the ICD-10-CM code set. Get a jump start in also preparing for the 2024 CPT updates that will be effective Jan. 1, 2024. Most importantly, educate your staff to ensure they are using the correct 2024 new and revised codes to avoid claim denials due to invalid diagnosis or procedure codes. Section 1.7.11 of the TMHP manual (Provider Enrollment and Responsibilities) provides clear directives as to what Providers cannot bill eligible clients for. Some examples are: ■Failure to submit a claim, corrected claim, or appeal within set deadlines. ■Filing an incorrect claim. ■Failure to obtain authorization for services requiring one. ■Failure to submit a claim within 95 days from the disposition date from a primary insurance (including Medicare). Additionally, Providers cannot require a down payment for Medicaid-covered services. If your contract or credentialing has not been finalized or there are any issues with licenses, attestation, or certificates that cause denial of a claim, it is the Provider’s responsibility to resolve the matter in a timely manner. Clients are not to be billed. Please review the complete section along with your office / billing staff to ensure compliance with the Texas Medicaid program. If you have questions, please feel free to contact Member Services at 915-532-3778 or toll-free at 1-877-532-3778. Medicaid and CHIP members are not to be billed for allowable services
2 stay informed Artificial intelligence is emerging rapidly in health care! One of the reasons artificial intelligence (AI) is becoming so prominent in medicine and health care is the increasing availability of healthcare-related big data from sources such as electronic medical records. This data can be analyzed by AI tools and algorithms (advanced computer programs) to provide valuable insights and support health-care workers. One of the ways AI can help us is by addressing challenging areas like chronic-disease management and clinical decision-making. It does this by understanding better predictors of disease that doctors can use to become more precise and efficient, reducing the burden of performing complex and expensive tests and procedures. AI algorithms have also been shown to reduce health-care costs by preventing adverse events such as hospital readmissions by analyzing patient data and identifying contributing factors. AI even helps catch bad actors faster by detecting fraud, waste, and abuse in real time before a potentially fraudulent claim is ever paid out. This further helps reduce health-care costs and malpractice insurance. But despite AI’s many benefits, it is crucial for us to always prioritize patient privacy and ensure the security of sensitive medical information. Responsible and ethical implementation of AI in health care is essential to protect patient confidentiality and maintain trust in the health-care system. Before working with AI tools, health-care workers should carefully consider, question, and address any ethical and privacy concerns that may arise. It’s clear that AI technology is here to stay as it continues to revolutionize the health-care industry, but we must not forget that privacy and security also continue to be critical aspects that need to be safeguarded first.
3 stay informed EL PASO CHILDREN’S HOSPITAL FEATURED PROVIDER Expanding our expertise David Jara, MD, is a boardcertified physician in pediatrics and allergy and immunology who has joined the El Paso Children’s Hospital team. Dr. Jara is an El Paso native with over 10 years of experience caring for kids. He completed medical school and his pediatric residency at the University of Texas Medical Branch in Galveston before completing a fellowship in allergy and immunology at Children’s Mercy Hospital in Kansas City, Missouri. He also has over 7 years of experience working in their Urgent Care Center. Dr. Jara is excited to be back home and hopes to give back to the community by providing quality care to children with allergies and immunological problems. Being board-certified in both pediatrics and allergy and immunology allows him to tailor management of childhood diseases. His experience in acute care medicine has also helped him identify gaps in patient care that may lead to loss of management or control of a child’s medical condition. He is a great addition to the team and will work collaboratively with several of our other specialists to improve health outcomes in the region. Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. The services 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-service to your staff, please call the Outreach Coordinator at 915-532‑3778, Ext. 1075. David Jara, MD
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 1-877-532-3778, 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 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP7902310 – EPH-PR-Winter 2024 Provider Newsletter 2023 © Coffey Communications, Inc. All rights reserved. stay informed EVV required for Medicaid Home Health Services, effective January 2024 Electronic visit verification (EVV) is a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the: ■Member receiving services. ■Attendant providing services. ■Location of service delivery. ■Date of service delivery. ■Time the attendant begins and ends service delivery. The EVV program was implemented to replace paper-based attendant timesheets. Texas requires EVV for certain Medicaid-funded home and communitybased services provided through the Health and Human Services Commission and managed care organizations. Effective Jan. 1, 2024, EVV is required for Medicaid home health-care services through the 21st Century Cures Act. What programs, services, and service delivery options are newly required to use EVV? Home health-care services are required for the State of Texas Reform Access (STAR) program. These service Providers include: ■In-home skilled nursing visits. ■Occupational therapist services provided in the home. ■Physical therapist services provided in the home. ■Personal care services provided by a home health aide in the home under the supervision of an RN, occupational therapist, or physical therapist. Communications have been ongoing, so don’t delay—make certain you are set up and are updated with all the changes now. For more information, please visit the following websites for resources. Or contact Provider Relations at 915-532-3778 or email us at EPH_EVV@elpasohealth.com. Additional EVV resources ■HHS: hhs.texas.gov/providers/longterm-care-providers/long-term-careprovider-resources/electronic-visitverification-evv ■TMHP: tmhp.com/topics/evv ■EPH: elpasohealth.com/providers/evv Preparing for HEDIS season The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most used performance improvement tools, and it is just around the corner. HEDIS season is scheduled to kick off in January 2024, and you will be receiving official medical record requests from El Paso Health. Medical record requests are sent out to our network Providers to obtain medical records for data that has not been captured in claims. Once you are ready, you can submit the medical records in one of four ways: ■Secure fax ■Secure email ■Mail ■Pickup Please consider electronic data sharing, as this facilitates the process. Help us have a successful HEDIS season. El Paso Health and your patients will thank you. For NCQA HEDIS measures and technical resources, visit ncqa.org/hedis/measures.
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