REMINDER: PHYSICIAN PATHOLOGY AND LABORATORY SERVICES

August 31, 2016

The Missouri Medicaid Audit and Compliance Unit (MMAC) is providing the following reminders for physicians and  laboratories that are enrolled in MO HealthNet and for hospitals that bill for non-enrolled laboratory services.

 

The MO HealthNet provider manual for physicians sets forth the following requirements:

 

An outside laboratory performing outpatient laboratory services must bill MO HealthNet for the services when the laboratory is an enrolled MO HealthNet provider.  A hospital may bill MO HealthNet for outpatient laboratory services performed by a non-MO HealthNet enrolled outside laboratory. Physician offices may bill for initial drug screens performed at point of care, and hospital laboratories may bill for screenings they performed, but both cannot be billed.  It shall be the responsibility of the ordering physician to coordinate with the performing laboratory for the billing of drug screen tests. Providers should not routinely bill for the quantification of drug classes.  Providers should only bill for the quantification of a drug class or a confirmatory drug test if there is a positive screen for the drug class to be quantified.  Quantification or confirmatory drug tests for a specific substance may be ordered if medically necessary.  Documentation of medical necessity must be recorded in the patient medical record.

CONSUMER-DIRECTED SERVICES (CDS) VENDOR RESPONSIBILITIES

August 30, 2016

The CDS Vendor’s responsibilities can be found in Missouri state regulation, at 19 CSR 15-8.400.  The Missouri Medicaid Audit and Compliance Unit (MMAC) would like to encourage CDS vendors to be familiar with the program’s responsibilities and requirements.  Some of the requirements are listed below:

 

Collect timesheets and certify their accuracy Transmit individual payments to the personal care attendant on behalf of the consumer Ensure all payroll, employment, and other taxes are paid timely Ensure each attendant is registered, screened, and employable pursuant to the FCSR, the EDL, and applicable state laws and regulations Ensure the attendant is not the consumer’s spouse Perform case management activities with the consumer at least monthly to provide ongoing monitoring of the services Ensure the consumer is properly trained to properly recruit, employ, instruct, supervise, and maintain the services of the attendant(s).  This training and orientation includes, but is not limited to the following: Time sheet preparation Identification of program fraud Allowable and non-allowable tasks Attendants’ rights and responsibilities Identification of abuse, neglect, and exploitation

 

If you have any questions, please contact MMAC at mmac.providerreview@dss.mo.gov