You can send your immunization questions to:

immunizations@kansasaap.org

We look forward to being your resource for immunization needs.

The Children’s Initiatives Fund (CIF) plays a large role in funding children’s programs in Kansas, in the past many programs that received CIF funding focused on early childhood, health, mental health and child welfare.  The link below is an Issue Brief developed by the Kansas Health Institute, a nonprofit, nonpartisan, independent health policy and research organization that explains the origin of CIF and what the future may hold for the programs supported by CIF.

Children’s Initiatives Fund Issue Brief

To get your certificate for attending the meeting, fill out this survey:

http://www.surveymonkey.com/s/2013CME_v3

On Thursday, March 28, time allotted for the Rapid Response Call will be increased in length by 30 minutes, with the call open from 9-10:30 a.m.

Starting April 2, the KanCare Rapid Response Call will be held three times per week in preparation for any issues related to the April 4 end to the member choice period. These calls will start at 9 a.m. on Tuesdays, Thursdays and Fridays.

During the KanCare Rapid Response Call, we welcome consumers, providers and other stakeholders to join the phone line and ask questions about their individual needs as it pertains to the transition to KanCare.

To join the call, dial (877) 247-8650 and use ID Code #79687456.

KAAP members have reported problems with the acceptance of billing for vaccines and this bulletin addresses the issues so that providers are paid for services:

On January 1, 2013, new Procedure-to-Procedure (PTP) edits were implemented in the Medicaid National Correct Coding Initiative (NCCI) that pair the immunization administration codes (CPT® codes 90460-90474) as column one codes with the preventive medicine evaluation and management (E&M) service codes (CPT codes 99381-99397) as column two codes. All of the edits have a Correct Coding Modifier Indicator (CCMI) of “1”, which will result in the edit being bypassed, if a PTP-associated modifier, such as modifier 25, is correctly appended to the preventive medicine code. If a PTP-associated modifier, such as modifier 25, is not appended to preventive medicine code and, if both codes are reported on the same date of service, the column two code (i.e., the preventive medicine service) will be denied.

The edits are based on the instruction in the section on “Immunization Administration for Vaccines/Toxoids” in the 2013 CPT Manual.

A provider indicates on a claim that an E&M service is significant and separately identifiable from other services performed by appending modifier 25 (“Significant, Separately Identifiable Evaluation and Management Service by the Same Physician . . .”) to the E&M service code. It is understood that immunizations are commonly administered in conjunction with a comprehensive preventive medicine evaluation and that, when this occurs, both services are payable. If a provider administers immunization(s) and performs a significant, separately identifiable preventive medicine E&M service on the same date of service, reporting the E&M service with modifier 25 will bypass the NCCI PTP edit.

The edit prevents inappropriate payment of a preventive medicine E&M service, if the beneficiary just comes to the physician’s office for an immunization on a day other than the day of a comprehensive preventive medicine E&M service.

If a claim for a preventive medicine E&M service is denied because a provider did not append modifier 25 to that code, when it would have been appropriate to do so, the claim may be resubmitted with modifier 25 appended to the preventive  medicine code. Providers can resubmit claims for previously denied preventative E&M procedure codes.

Please refer to the Medicaid NCCI web page on the Medicaid.gov website to obtain additional information about the Medicaid National Correct Coding Initiative.

Download full bulletin here

As KAAP has noted in previous mailings (as part of the ACA payments to Medicaid), providers are scheduled to increase to Medicare rates effective January 1, 2013.  Providers won’t receive payments reflecting this increase immediately.  The State must first submit a State Plan Amendment to CMS for approval January 1.  We will not know how providers in Kansas will receive the payments until after the Plan has been approved by CMS.  The increases will not be automatic to providers.

Providers must complete a one-page attestation form and mail it to the State.  The Kansas Medical Society (KMS) recommends that the forms be completed and sent in to the address below by February 15.

Follow the procedure below to complete the Attestation for Primary Care form:

• Click here to access the attestation form or use this link https://www.kmap-state-ks.us/Documents/Content/Forms/Certification_Attestation_PCP.pdf
• Download and print the form
• Fill out the required sections
• Mail form to:

KDHE-DHCF
Attn: Roxana Alexander
900 SW Jackson, 9th Floor
Topeka, Kansas 66612

Cavity Free Kids recently did a training at the Health Partnership Clinic in Overland Park, and here is what Kelly Kreisler, MD, MPH, Chief Medical Officer had to say, “The staff of Health Partnership Clinic really appreciate the Kansas Chapter of the AAP for increasing our awareness about the importance and ease of fluoride application in the primary care setting!   Since we focus on serving those at most risk, we are especially thankful that we were able to get started with the applications that same afternoon. Dr. Pham was knowledgeable, answered all of our questions, and gave our staff the confidence to begin the applications immediately. Thanks again for your support!”

For more information on Cavity Free Kids and how you can participate, click here.

Applying flouride varnish just takes seconds!

On January 1, 2013 the Centers for Medicare and Medicaid Services (CMS) released the latest version of the National Correct Coding Initiative (NCCI) edits. The NCCI edits are code edits published by both Medicaid and Medicare to support correct coding and claims adjudication. Included in the new Medicaid and Medicare edits were edits on all evaluation and management (E/M) services that disallow patient with immunization administration codes without the proper modifier. The modifier indicator for all these edits is a “1,” meaning that with proper modifier placement, the edit can be overridden.

While the Academy is urgently working with National Correct Coding Solutions – the CMS contractor for NCCI edits – to have the edits suspended on all preventive medicine service codes (99381-99385 and 99391-99395) with all immunization administration codes (90460 and 90461, 90471-90474). It should be noted that the edits are currently locked in and will continue to be in effect for Medicaid, Medicare, and private payers that implement CMS coding policies until such time that AAP advocacy efforts are successful. Over the past several days, the AAP has been in telephone contact with the highest levels of the CMS contractor responsible for the NCCI edits and has delivered a formal letter demanding retraction of these edits.

Therefore, effective immediately and for all claims submitted after January 1, 2013, AAP urges its members to append modifier 25 to the preventive medicine service code (99381-99395) when it is reported in conjunction with any immunization administration service (90460-90461; 90471-90474).

A modifier 25 should also be appended to other non-preventive medicine E/M services (eg, 99201-99215) when reported in conjunction with immunization administration — but only when the E/M service is significant and separately identifiable.

We understand this is an administrative burden for you and your staff. The AAP is working diligently to unlock this change and will forward additional information on this issue as it becomes available.

Please contact the AAP Coding Hotline with any questions or issues: aapcodinghotline@aap.org

Thank you.