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Mississippi Medicaid Billing Boosters January 2015

PCP Bonus

The federal Primary Care Physician program may have ended in 2014, but during 2014 the Mississippi DOM was granted authority by the Legislature to CONTINUE reimbursing eligible providers, as determined by the ACA, at 100 % of the Medicaid fee schedule. This bonus is available for qualifying physicians and non-physician practitioners.

Effective 7/1/2015, reimbursement of primary care services provided by eligible providers will be at 100% of the fee schedule in effect as of January 1 of each year. To receive the bonus, providers who qualify must accurately “self-attest” by completing the 1/1/2015-6/30/2016 Self-Attestation Statement Form. Don’t delay! The deadline to submit the Self-Attestation form to receive the bonus effective 1/1/2015 is 3/31/2015. [For more information click Here.]

Bilateral Surgical Procedure Billing Guidelines

The ACA mandated that state Medicaid programs abide by CMS Medicaid NCCI edit standards. To comply with this requirement, DOM will now process claims containing bilateral surgical procedure codes following NCCI standards. DOM implemented the edit on 12/1/2014 and the changes apply to claims beginning with dates of service 1/1/2013. Reprocessing will occur in the near future.

The system will calculate the highest reimbursing code and then apply the bilateral surgical procedure code calculation. Bilateral surgical procedure codes will deny for NCCI edit 6560 if billed with more than 1 unit. All procedures must be billed on the same claim unless insufficient lines are available.

Bilateral surgical procedure codes will require modifier -50 if the procedure was performed on both anatomical sides. If the procedure was performed on one anatomical side, the provider should bill modifier –LT or –RT indicating which side the procedure was performed. Providers should NOT bill modifiers –LT or –RT with modifier -50. (Edit 1003: Modifier-50 is not allowed on non-bilateral procedure codes.)

The list of bilateral surgical procedure codes that will have the edit applied are located Here.

After-Hours Premium

Did you know that DOM will pay a premium for an after-hours visit? Medicaid reimburses a fee in addition to the appropriate E&M code when the visit:

  • Occurs during the provider established office hours which are set outside the DOM definition of office hours; or

  • Occurs outside of office hours or provider established office hours only for a condition which is not life-threatening but warrants immediate attention and cannot wait to be treated until the next scheduled appointment during office hours or provider established office hours.

Codes 99050 or 99051 each pay $15 and would be added to the base E&M code.

  • 99050- Services provided in the office at times other than regularly scheduled office hours, or days when office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service.

  • 99051- Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

Documentation should include the practice’s stated office hours, the time of the visit and the visit circumstances.

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