Hurricane Katrina Information for Mississippi Hospitals

CMS Issues New Disaster Condition Code and Modifier for Katrina Claims

CMS published a bulletin about new codes for disaster-related claims. The agency said to facilitate claims processing and track services and items provided to victims of Hurricane Katrina and future disasters, CMS established a new condition code and modifier for providers to use on disaster related claims. (MedLearn Matters MM4106)

The new condition code and modifier are for use by providers submitting claims for beneficiaries who are Katrina disaster patients in any part of the country and are effective for dates of service on and after August 21, 2005. The new codes are the following:

· The new condition code is DR - Disaster Related;
· The new modifier is CR - Catastrophe/Disaster Related.

For physicians or suppliers billing their local carrier or DMERC, only the modifier (CR) should be reported and not the condition code. A condition code is used in FI billing. For institutional billing, either the condition code or modifier may be reported. The condition code would identify claims that are impacted or may be impacted by specific payor policies related to a national or regional disaster. The modifier would indicate a specific Part B service that may be impacted by policy related to the disaster.

CR4106 instructs Medicare contractors to recognize the new condition code and modifier on October 3, 2005, if possible, but no later than October 31, 2005. In addition to this Medlearn Matters Article, CMS regional offices will help facilitate contractor outreach regarding provider education on the use of the new modifier and condition code.

[ via Medical News Today ]

Katrina hampers data-collection efforts in the Gulf region

Hurricane Katrina may impact the ability of some Gulf Coast hospitals to report quality data to CMS, an American Hospital Association official told the federal government last week.

The storm, which struck Louisiana, Mississippi, and Alabama on August 29, damaged or destroyed many medical records at affected hospitals, Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told the Agency for Healthcare Research and Quality. The damaged records may prevent hospitals from abstracting data to report to CMS and its Hospital Compare Web site, www.hospitalcompare.hhs.gov.

Many of the hospitals that continued operating after the hurricane are now treating patients transferred from other areas, Foster said, which can hinder data-collection efforts because the hospitals do not have complete information for those patients.

Officials from the Hospital Quality Alliance, the public-private collaborative that promotes data reporting and helped create the Hospital Compare site, are now determining how to proceed with data collection for the affected hospitals, Foster said.

[ via Quality Improvement Monitor ]

CMS takes emergency steps to ease health care access for emergency evacuees

The Centers for Medicare & Medicaid Services has adopted a series of emergency policy changes to accommodate the needs of thousands of displaced Medicaid and State Children’s Health Insurance Program (SCHIP) beneficiaries who have fled Hurricane Katrina and need urgent medical attention in their new host states.

As announced by President Bush, special evacuee status will be granted to all those who fled states because of Hurricane Katrina. This designation will allow those persons to apply for the full range of federal benefits administered by the states without having to produce the normal forms of documentation to verify eligibility.

These programs include Medicaid; SCHIP; temporary assistance for needy families; child care; mental health services and substance abuse treatment; food stamps; housing; foster care; women, infants and children nutrition; school lunch; unemployment compensation; and job training.

Accordingly, CMS is working with affected states to develop a new Medicaid and SCHIP application template, through which states may be granted emergency section 1115 demonstrations to provide temporary eligibility for all eligibility groups. Using this new program, evacuees displaced because of the storm will be able to quickly enroll in Medicaid or the State Children’s Health Insurance Program (SCHIP) in the state to which they have been evacuated. Applications will be accepted retroactively from August 24, 2005.

The administration is working with Congress to provide financial support to states that provide Medicaid and SCHIP coverage to evacuees who are currently residing in their states. Consequently, CMS is allowing states to count the full expected cost of these temporary programs in their financial statements to determine federal payments.

Among the Medicaid and SCHIP changes available through the special Section 1115 demonstration initiative will be:

• Waiver of the normal document requirements verifying their Medicaid or SCHIP status in their home states or any information relating to household income or employment;
• Provision of temporary eligibility to applicants who are already enrollees in their home state. During the period of presumptive eligibility, the host state is required to verify circumstances of eligibility to the extent possible;
• Evacuees may apply using a simplified application in the host state.
• Host states, at a minimum, will provide their own Medicaid and SCHIP benefit packages to the evacuees;
• Host states must extend the expedited application process to evacuees who may be newly eligible because of new economic circumstances created by the hurricane (i.e. loss of job and income that may have made them ineligible prior to the storm.)
• Host states will submit their estimated expenditures to CMS as a component of their usual cost reporting for determining federal payments.

CMS has assigned staff to work with all states who are hosting evacuees to provide speedy access to Medicaid and SCHIP benefits to those in need.

CMS actions to help Hurricane Katrina victims

The Centers for Medicare & Medicaid Services has acted to assure that the Medicare, Medicaid and State Children's Health Insurance Programs will flex to accommodate the emergency health care needs of beneficiaries and medical providers in the Hurricane Katrina-devastated states.

Many of the programs' normal operating procedures will be relaxed to speed provision of health care services to the elderly, children and persons with disabilities who depend upon them.

Because of hurricane damage to local health care facilities, many beneficiaries have been evacuated to neighboring states where receiving hospitals and nursing homes have no health care records, information on current health status or even verification of the person's status as a Medicare or Medicaid beneficiary. CMS is assuring those facilities that in this circumstance the normal burden of documentation will be waived and that the presumption of eligibility should be made.

Federal Medicaid officials are also working closely with state Medicaid agencies to coordinate resolution of interstate payment agreements for recipients who are served outside their home states.

The agency will also offer the following relief immediately:

* Health care providers that furnish medical services in good faith, but who cannot comply with normal program requirements because of Hurricane Katrina, will be paid for services provided and will be exempt from sanctions for noncompliance, unless it is discovered that fraud or abuse occurred.

* Crisis services provided to Medicare and Medicaid patients who have been transferred to facilities not certified to participate in the programs will be paid.

* Programs will reimburse facilities for providing dialysis to patients with kidney failure in alternative settings.

* Medicare contractors may pay the costs of ambulance transfers of patients being evacuated from one health care facility to another.

* Normal prior authorization and out-of-network requirements will also be waived for enrollees of Medicare, Medicaid or SCHIP managed care plans.

* Normal licensing requirements for doctors, nurses and other health care professionals who cross state lines to provide emergency care in stricken areas will be waived as long as the provider is licensed in their home state.

* Certain HIPAA privacy requirements will be waived so that health care providers can talk to family members about a patient's condition even if that patient is unable to grant that permission to the provider.

* Hospitals and other facilities can be flexible in billing for beds that have been dedicated to other uses, for example, if a psychiatric unit bed is used for an acute care patient admitted during the crisis.

* Hospital emergency rooms will not be held liable under the Emergency Medical Treatment and Labor Act (EMTALA) for transferring patients to other facilities for assessment, if the original facility is in the area where a public health emergency has been declared.

More information about CMS emergency relief activities, including a detailed explanation of billing and payment policy revisions, and phone numbers for the state medical assistance offices can be found can be found here. Frequently asked questions and their answers on the site will be updated daily by 2 p.m.

CMS actions to help beneficiaries, providers in Katrina-stricken areas

The Centers for Medicare & Medicaid Services has acted to assure that the Medicare, Medicaid and State Children’s Health Insurance Programs will flex to accommodate the emergency health care needs of beneficiaries and medical providers in the Hurricane Katrina devastated states.

Many of the programs’ normal operating procedures will be relaxed to speed provision of health care services to the elderly, children and persons with disabilities who depend upon them.

Because of hurricane damage to local health care facilities, many beneficiaries have been evacuated to neighboring states where receiving hospitals and nursing homes have no health care records, information on current health status or even verification of the person’s status as a Medicare or Medicaid beneficiary.  CMS is assuring those facilities that in this circumstance the normal burden of documentation will be waived and that the presumption of eligibility should be made.   

Federal Medicaid officials are also working closely with state Medicaid agencies to coordinate resolution of interstate payment agreements for recipients who are served outside their home states.

The agency will also offer the following relief immediately:

• Health care providers that furnish medical services in good faith, but who cannot comply with normal program requirements because of Hurricane Katrina, will be paid for services provided and will be exempt from sanctions for noncompliance, unless it is discovered that fraud or abuse occurred.
• Crisis services provided to Medicare and Medicaid patients who have been transferred to facilities not certified to participate in the programs will be paid.
• Programs will reimburse facilities for providing dialysis to patients with kidney failure in alternative settings.
• Medicare contractors may pay the costs of ambulance transfers of patients being evacuated from one health care facility to another.
• Normal prior authorization and out-of-network requirements will also be waived for enrollees of Medicare, Medicaid or SCHIP managed care plans. 
• Normal licensing requirements for doctors, nurses and other health care professionals who cross state lines to provide emergency care in stricken areas will be waived as long as the provider is licensed in their home state.
• Certain HIPAA privacy requirements will be waived so that health care providers can talk to family members about a patient’s condition even if that patient is unable to grant that permission to the provider.
• Hospitals and other facilities can be flexible in billing for beds that have been dedicated to other uses, for example, if a psychiatric unit bed is used for an acute care patient admitted during the crisis.
• Hospital emergency rooms will not be held liable under the Emergency Medical Treatment and Labor Act (EMTALA) for transferring patients to other facilities for assessment, if the original facility is in the area where a public health emergency has been declared.

More information about CMS emergency relief activities, including a detailed explanation of billing and payment policy revisions, and phone numbers for the state medical assistance offices can be found can be found at www.cms.hhs.gov.  Frequently asked questions and their answers on the site will be updated daily by 2pm.

Hurricane Katrina Medicare Contractor and CMS Regional Office Contacts

The following individuals are the point staff for provider calls. CMS requests that the provider use the regular customer services lines but the following numbers are available if the provider does not receive an answer or is not satisfied with the answer he/she receives:

Trispan – Angela Davenport (601) 664-4466

Mutual – Shirley Vosika 1-(866) 734-9444 ext 2273

Cahaba MS – John Cook (601) 977-5850

Cahaba AL – Scott Shelton (205) 220-1336

Cahaba IA – Susan Pretnar (515) 471-7302

Palmetto (DMERC) – Robin Spires (803) 788-0222

Palmetto (RHHI) – Marilyn Reser (803) 763 1856 (South Carolina)

Marjorie Webber (727) 773-9225 ext. 15360 (Florida)

Arkansas BCBS (FI and carrier) – Kay Werner (501) 210-9254

TrailBlazer Health Enterprises (FI and carrier) – Pat Lewis (903-463-8054) prefers e-mail contact @ p.lewis@trailblazerhealth.com

If the provider cannot get through or does not get a response from the Medicare contractors, the provider may call the following staff in the appropriate regional offices:

Atlanta Regional Office

Mike Taylor (404) 462-7374

Colleen Carpenter (404) 562-7242

General Line – (404) 562-7390

Dallas Regional Office

Paula Hammond – (214)-767-8123

Jimmy Sigmund – (214)-767-0250

General Line – (214)-767-6401

Kansas City Regional Office

Phil Chiarelli - (816) 426- 5033

Jim Frisbie – (816) 426-6389