MISSOURI RECEIVES APPLICATION FEE WAIVER FOR CERTAIN PROVIDER TYPES
State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require MMAC to collect an application fee, currently set at $542.00, from all new and revalidating “institutional” Medicaid providers. “Individual” providers such as physicians, dentists and other individual non-physician practitioners are not required to pay the application fee.
Effective July 1, 2015, MMAC began collecting the required application fee from all new, reenrolling and revalidating MO HealthNet institutional providers.
Providers can request a hardship waiver of the application fee from CMS, but the fee must be submitted before the application will be processed by MMAC. If CMS approves the hardship waiver, MMAC will refund the application fee to the provider. Click here for more information regarding requesting a hardship waiver from CMS.
Providers who paid the $542 fee to Medicare or another state Medicaid agency will be exempt from paying an application fee.
The only providers who will be paying the required application fee during state fiscal years 2016 and 2017 (July 1, 2015 to June 30, 2017) will be newly enrolling institutional providers.
There are various payment options for providers that are required to submit the application fee during state fiscal year 2016 and state fiscal year 2017:
You may pay electronically using a credit card, debit card or e-check through the contracted state vendor, Collector Solutions. A convenience fee will apply, depending on the form of electronic payment selected. Click here for Collector Solutions website. The vendor will provide a receipt reflecting the application fee was paid which can be submitted to MMAC with your application. Providers also have the option of submitting a cashier’s check or money order, made payable to DSS-MMAC Application Fee. Cash and personal/business checks will not be accepted. Mail your check to: For more information about hardship waivers, please click here.
On August 14, 2015, MMAC received an exemption waiver from CMS for several provider types, when the provider is publicly funded. Click here to read the letter. Specifically, the waiver applies to government-operated providers which are publicly funded, such as those operated by city, municipal, county, and state agencies. As of this date, this applies to all 325 enrolled school-based services providers, all 104 enrolled public health departments, all 13 enrolled long term care state institutions, and all three (3) enrolled state mental hospitals. It also applies to some providers in other categories. If you are uncertain whether this applies to you, please contact MMAC at mmac.providerenrollment@dss.mo.gov or by calling (573) 751-8619. If this waiver does not apply to you, you may still request a hardship waiver directly from CMS.
If you have any questions regarding whether or not the exemption covers you, please contact MMAC at MMAC.ProviderEnrollment@dss.mo.gov or at 573-751-3399 (request provider enrollment.)
Providers who self-audit and discover overpaid amounts are able to “self-disclose” or report those findings. The findings, along with repayment, can be sent to Missouri Medicaid Audit & Compliance (MMAC) by using the Self Disclosure Form, located here. Providers do not have to submit multiple checks, as the form allows for a detailed, line-item description of the amount(s). Submitting one check per disclosure form (for multiple disclosures) is preferable.
Cognosante, LLC is the RAC for Missouri. Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments.
Should you receive any communication from an entity representing itself on behalf of Missouri Medicaid Audit and Compliance (MMAC), or Cognosante, and you are concerned about the legitimacy of the person or company, you should contact MMAC at (573) 751-3399 to verify the communication or request is legitimate.
In 2015, the RAC will finish its work on outstanding pharmacy and durable medical equipment (DME) audits, and will begin conducting audits of hospital billing submitted by enrolled Missouri hospital providers. The RAC may request documentation to support billing of outpatient encounters, including professional and facility services. The RAC will review paid claims for proper billing of both professional and facility services, and the appropriate utilization of facility resources, such as supplies and facility charges. Documentation requests may include requests for itemized statements, medical records, medication administration records, radiology interpretations, and laboratory results to support the claims submitted for payment.
The RAC will begin issuing medical records requests to those hospitals selected for audit beginning July 2015.
Brown Smith Wallace LLC, Missouri’s EHR Audit Contractor
As part of the ongoing program to monitor MO HealthNet’s Electronic Health Record (EHR) Incentive Program payments, the Missouri Department of Social Services has contracted with Brown Smith Wallace LLC to conduct reviews of payments made to participating hospitals and professionals for program year 2013.
Federal regulation 495.368 requires States to comply with Federal requirements to combat fraud and abuse. Brown Smith Wallace LLC is authorized to conduct post-payment audits through desk and/or on-site reviews. Selected hospitals and professionals will receive a letter of notification indicating that they have been chosen for a review.
The purpose of the audit is to validate certain information utilized as the basis for dispersing an incentive payment, including information used in eligibility determinations and hospital payment calculations. Section 1903(t)(2) of the HITECH Act states that all Eligible Professionals and Hospitals need to meet certain patient volume thresholds in order to be eligible for Electronic Health Record incentive payments.
Information Required of Eligible Professionals and Hospitals
The following information may be required from eligible professionals and hospitals. A tip sheet with more detailed descriptions is referenced in the last bullet under each heading below.
Eligible Professionals:
Detailed encounter listing to support the numerator and denominator utilized in the eligibility calculation, Documentation to support an eligible professional’s affiliation with locations for which patient encounter volume was reported, Documentation to support an eligible professional’s affiliation with a group practice when that eligible professional utilized the group proxy to report encounter volume, and When appropriate, documentation to confirm the provider or provider organization had a legal or financial obligation to the Certified Electronic Health Record Technology at the time of A/I/U (Adopt, Implement, or Upgrade) attestation. A tip sheet for eligible professional: https://dss.mo.gov/mhd/ehr/pdf/post-payment-review-tips-eligible-professional.pdf
Eligible Hospitals:
Detailed encounter listing to support the numerator and denominator utilized in the eligibility calculation, Documentation to support discharges according to the applicable cost reports or other documentation utilized in calculating the growth rate and discharge-related amount, Documentation to support the Acute Medicaid Days, Acute Medicaid HMO days, and Total Acute days utilized in calculating the Medicaid share, Documentation to support Charity Care Charges and Total Hospital Charges utilized in calculating the Medicaid share, and When appropriate, documentation to confirm the hospital had a legal or financial obligation to the Certified Electronic Health Record Technology at the time of A/I/U (Adopt, Implement, or Upgrade) attestation. A tip sheet for eligible hospitals: https://dss.mo.gov/mhd/ehr/pdf/post-payment-review-tips-eligible-hospitals.pdfMissouri Medicaid Audit & Compliance (MMAC) has begun implementing new provider enrollment procedures including provider revalidation. Any provider whose address has changed since initial enrollment should submit the updated information to MMAC by downloading the “Provider Update Request” form at https://mmac.mo.gov/providers/provider-enrollment/new-providers/provider-enrollment-forms/. The completed forms can be scanned and sent by e-mail to mmac.providerenrollment@dss.mo.gov or they can be faxed to the Provider Enrollment Unit at (573) 751-5065.
Be sure to check MMAC’s website regularly to get information on upcoming changes and other helpful tips for MO HealthNet providers.
State and federal regulations require all currently enrolled Medicaid providers to revalidate their enrollment at least every five (5) years. MMAC has established a revalidation schedule for all currently enrolled providers. MMAC will contact currently enrolled providers approximately 120 days prior to their scheduled revalidation due date. Instructions and forms will be provided by mail or e-mail. More information on revalidation is available under the Providers tab here on our website. Under the Providers tab, choose Provider Enrollment, and Revalidating Providers.
