Physician Billing Webinar

Illinois Department of Healthcare and Family Services

September 10, 2014

What’s New at HFS?

**Providers are encouraged to review this site for possible explanation to their billing questions or issues before contacting a billing consultant**

  • Non-Institutional Providers Resources is designed to assist Non-Institutional Providers with HFS billing and payment for services, as well as provide answers to frequently asked questions and links to webinar slides.

  • Family Planning Changes

  • Senate Bill 741

  • Tobacco Cessation Coverage

Family Planning Changes

Dispensing Fee

Vaginal Ring, Contraceptive Patch and Oral Contraceptives

Emergency Contraceptive Pills

Adjustments

Senate Bill 741 Medicaid Benefit Changes 

Update to Adult Dental Coverage

Tobacco Cessation Counseling Services

Duration of Counseling

Pharmacotherapy

Reminder: Annual Medical Cards

Affordable Care Act (ACA) Increased Payment for Primary Care Services

Provider Attestation

APNs and ACA Payments

Allowable CPT Codes

Allowable Vaccine CPT Codes and Charges

Electronic Remittance Advice

Paper Remittance Advice

Adjustments with Reason Code 3314

Adjustments with Reason Code 3317

Home Health Care Services

Four Prescription Policy

Changes to Illinois Hemophilia Program

Sexual Assault Emergency Treatment Program

Services to Hospice-Enrolled Participants

Chiropractic Services

Group Psychotherapy

Prior Approval for Surgeries for Morbid Obesity

340B Purchased Drugs

$12 Dispensing Fee for 340B Purchased Drugs

Provider Rate Reductions

180 Day Time Limit for Claim Submittal

Exceptions to the 180 Day Time Limit

Written requests for timely filing overrides for any of the exceptions in the following slides, and as stated in the July 23, 2012 provider notice, require a manual override and must be submitted with an original clean claim form and any attachments as indicated in the following slides to:

HFS – Bureau of Professional and Ancillary Services (BPAS)
Attn:  Practitioner Billing Consultant
P.O. Box 19115
Springfield, IL  62794-9115

*Timely filing will be the only edit authorized for bypass. Should there be rejections due to billing errors unrelated to timely filing, those claims will not be allowed another time override.

Co-Pays/Cost Sharing

Participants excluded from cost sharing include:

Services exempt from cost sharing include:

Co-Pays/Cost Sharing for IHW

Services and co-payment amounts for participants enrolled in the Illinois Health Women program, effective with dates of service on or after July 16, 2012 as a result of the SMART Act include:

Co-pays/Cost Sharing and TPL

Fee-For-Service Billing by Hospitals

Services billable FFS by hospitals:

**PLEASE NOTE: although previously billable, Synagis is no longer reimbursed FFS to hospitals effective April 1, 2014 per policy stated in the June 2, 2005 provider notice. A notice to clarify this policy is forthcoming.

Payment for Chemotherapy Services

Office Visits

EPSDT Codes

Additional information may be found in the Healthy Kids Handbook (HK-200) & Appendices

Adult Preventive Services

BMI Assessment & Obesity-Related Weight Management Follow-Up for Children & Adolescents

Prenatal/Perinatal Services

Additional information is available

Newborn Eligibility

Newborn Care

Concurrent Care

Critical Care

Hospital Care

Observation

Inpatient Care

Refer to Chapter 200, Topics A-220.4 and A-220.5 for further information and billing guidelines

Consultations

Anesthesia Services

Surgical Services

Multiple Radiology Procedures

Therapy Services

IHW/Family Planning

Provider Fee Schedules

Third Party Liability

**for discrepancies between TPL reported by participants and that seen on MEDI please contact the TPL unit at 217-524-2490

HFS Paper Claim Forms

**Please refer to instructions in the appendices for details regarding required, conditionally required, and optional fields

HIPAA 5010

Medical Electronic Data Interchange (MEDI)

Voids & Replacement Claims

Referring/Ordering Practitioner

National Correct Coding Initiative (NCCI)

ICD - 10

Common Billing Errors

Chapter 100 Handbook, Appendix 5 details HFS remittance advice error codes

Contact Numbers for Billing Questions or Prior Approval

Main Number :  877-782-5565

**Please Note: Claim status is not available by phone. Claim status is available using MEDI, the 835 ERA, and the paper remittance advice.

HFS Illinois

  


Non-Institutional Providers

 

 Need Assistance?

 


Illinois Bicentennial