Medicaid News Archive
Please select the links below for complete Medicaid articles and events from past years. View Current Medicaid News
General
09.03.09 New Medicaid injectable drug fee reportedly set for September 1
The Georgia Department of Community Health (DCH) has reported several developments on the health care provider fee schedule for the injectable drugs that are administered in an office or outpatient setting for Medicaid services in Georgia. DCH says...
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08.11.09 Georgia fee-for-service Medicaid Synagis policy for RSV season 2009-2010
The Georgia Department of Community Health (GDCH) announces its policy for Synagis (palivizumab) prophylaxis for its Fee-For-Service (FFS) members during the 2009-2010 respiratory syncytial virus (RSV) season based on the updated recommendations by the American Academy of Pediatrics (AAP).
Read DCH letter
06.05.09 DCH plan to cut injectables payment for Medicaid on hold
The Georgia Department of Community Health (DCH) says that it will place on indefinite hold its plans to reduce the maximum amount that health care providers can be paid for injectable drugs that are administered in an office or outpatient setting for Medicaid services in Atlanta.
DCH had proposed that the maximum amount that health care providers can be reimbursed for injectable drugs that are administered in an office or outpatient setting for Medicaid services in Atlanta be reduced to 80 percent of the 2007 CMS rate beginning July 1, 2009.
DCH Commissioner Rhonda Medows, M.D., says that DCH will continue to review "input and options." The proposed change would have affected Medicaid and PeachCare for Kids providers, including physicians, physician assistants, nurse midwifes, advanced nurse practitioners, podiatrists, oral maxillofacial surgeons, and related providers eligible to administer injectable drugs.
Both MAG and the Georgia Society of Clinical Oncology (GASCO) testified against the cuts at a meeting on May 26.
Written comments can be submitted to the Board of Community Health, P.O. Box 1966, Atlanta, GA 30303.
05.27.09 DCH calling for cut in reimbursement for injectables for Medicaid
The Georgia Department of Community Health has proposed that the maximum amount that health care providers can be reimbursed for injectable drugs that are administered in an office or outpatient setting for Medicaid services in Atlanta be reduced to 80 percent of the 2007 CMS rate beginning July 1, 2009. The Medicaid and PeachCare for Kids providers that are subject to this change include, but may not be limited to, physicians, physician assistants, nurse midwifes, advanced nurse practitioners, podiatrists, oral maxillofacial surgeons, and related providers eligible to administer injectable drugs. Both MAG and the Georgia Society of Clinical Oncology (GASCO) testified against the cuts at a meeting on May 26. Citizens wishing to comment in writing on the proposed changes should do so on or before June 4, 2009, to the Board of Community Health, P.O. Box 1966, Atlanta, 30303.
Read MAG's testimony to DCH
Notice from DCH
02.27.09 MAG-spurred DCH investigation results in OB/GYN practice payment
WellCare Medicaid CMO recently paid three claims to OB/GYN Associates in Dalton following an investigation that the Georgia Department of Community Health conducted at the request of the Medical Association of Georgia. WellCare had recouped payments in a manner inconsistent with the DCH Coordination of Benefits.
"These kind of recoupments occur on a routine basis all around the state, often improperly," says Cam Grayson, director of MAG’s Third Party Payer Advocacy program. "Our physicians should know the rules so they can assert their position when they are violated."
A summary of the rules governing the DCH Coordination of Benefits are available on the Third Party Payer page on www.mag.org. The site also contains the Georgia Families Contract compliance requirements.
Practices can also contact the following CMO representatives for additional information...
- WellCare of Georgia, Inc. - Ashley Cragin, Manager of Regional Provider Service, 678.327.0939 ext. 3058
- Peach State Health Plan - Kimberly Weakley, Manager of Provider Relations, 678.556.2422
- AMERIGROUP Community Care - Michelle Rush, Regional, Director of Operations-Southeast Market, 678.587.4840 ext. 74471
View DCH Coordination of Benefits and Georgia Families Contract compliance requirements
Read Wellcare's letter to providers
02.27.09 WellCare to reconcile CPT Code 59410/58670 payment errors
MAG recently discovered that WellCare Health Plan used incorrect DCH Physician Fee Schedule OB payment codes for some 20,000 obstetrical claims in Georgia during 2008. MAG says the error applied to at least two CPT codes, including CPT Code 59410 (vaginal delivery with post-op care) – which was paid at $755.54 versus the correct payment of $901.00, and Code 58670 (laparoscopy) – which was paid at $286.18 instead of $321.54. WellCare says that it will automatically adjust the applicable claims that are dated between October 1, 2008 and December 31, 2008. WellCare stressed that physicians/providers need not take any action, and it will contact the affected providers directly. The company says that the adjustments should be completed by March 1, 2009. MAG will take steps to ensure that the claims are paid in full. Contact Tsegereda Baptiste with MAG’s Third Party Payer Advocacy Department at 678.303.9277 or 800.282.0224 or tbaptiste@mag.org with questions.