Practice Management Insight

April 2012

A report on events affecting Oklahoma providers

April Fools

April 1 - 30

Alcohol Awareness Month

National Council on Alcoholism and Drug Dependence, Inc.

April 1 – 30

National Autism Awareness Month

The Autism Society

April 1 – 30

National Minority Health Month

Office of Minority Health

April 1 – 30

Occupational Therapy Month

American Occupational Therapy Association

April 1 – 30

STI Awareness Month

American Social Health

April 2 – 8

National Public Health Week

American Public Health Association

April 5

2010 Spring SoonerCare Provider Training Workshop

Oklahoma Health Care Authority (OHCA)

More Information

April 5

National Alcohol Screening Day

Screening for Mental Health, Inc.

April 5 – 6

Problem Gambling Core Level Training

Tulsa

More Information

April 7

World Health Day

Pan American Health Organization

April 8

Easter Sunday

April 10

SOC Family Support Provider Training

Tulsa

More Information

April 10 – 12

Joint Meeting on Adolescent Treatment Effectiveness: Collaborating and Integrating to Support Youth and Families in the Era of Change

SAMHSA, NIDA, NIAAA, OJJDP, etc.

More Information

April 11

Behavioral Health Advisory Council Meeting

OHCA

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April 11

Drug Utilization Review Board Meeting

OHCA

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April 11 – 12

2M2L Training

Guymon

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April 12

OHCA Board Meeting

OHCA

More Information

April 12 – 13

SOC Wraparound Training

OKC SM

More Information

April 13

Nicotine Dependence Treatment Symposium

Pontotoc Tech Center, Ada

More Information

April 15 – 17

Annual Mental Health & Addictions Conference

National Council for Community Behavioral Healthcare

More Information

April 16 – 20

RSS Training

OKC

More Information

April 19 – 20

Combined ASI/ASAM

ODMHSAS Training Center, OKC

More Information

April 19 – 22

Annual Medical-Scientific Conference

American Society of Addiction Medicine

More Information

April 21 – 28

National Infant Immunization Week

National Center for Immunization and Respiratory Diseases

April 21 – 28

Safe Kids Week

Safe Kids Worldwide

April 23

SOC Family Support Provider Training

OKC SM

More Information

April 25

Depth and Breadth of Understanding Self

OKC workshop

More Information

April 26 – 27

Case Mgmt Training

OKC

More Information

MARK YOUR CALENDAR

2012 Spring Provider Training Workshop

You and your staff are invited to attend the spring 2012 SoonerCare Provider Training Workshops hosted by the Oklahoma Health Care Authority (OHCA) and HP Enterprise Services. Workshops will include several specialty sessions for specific provider types. These workshops will be held in locations statewide, beginning April 5th.

Register for the 2012 Spring Provider Training Workshop

Do you realize that EDI software vendors, according to the state, may not be in compliance? Do you realize the EDI software vendors may be putting your agency in jeopardy? Are you at risk of going out of business by going against State Regulations?

According to the  Electronic Data Exchange Agreement, it states:

Electronic Data Exchange Agreement 4.2.4

“Factoring: Contractor shall not charge SoonerCare providers a percentage of the charges billed, or of the amount collected for Medicaid reimbursable services. Factoring is strictly prohibited under 42 CFR § 447.10.  Payments to business agents are regulated by 42 CFR § 447.10(f) (1)(3).  Contractor shall fully comply with the CFR regulations stated herein.  Failure to abide by these provisions shall result in immediate termination of this Agreement.  This provision shall survive termination or expiration of this Agreement.”

President of OrionNet Systems LLC., Clyde Wafford, had this to say, “OrionNet Systems had the foresight and clarity to create a normal standard software package. ThinkHealth members have nothing to worry about.  We realized, a long time ago, that this was an unfair practice, and as most of you know, I do not want to be in your business or have my hands in your pocket.  It seems the OHCA agrees with us.  The question is, will OHCA go after the center or clinician if they are using such software?  I think they will go after the center.  But they might try to stop the EDI software vendor from billing to their system, so the agency would basically be using software that they cannot bill from.”

In a related issue, the Behavioral Health Advisory Council Meeting on April 11th 2012 discussed Medicaid regulations.

Since July 2011, thirty five contracts have been terminated due to more stringent Medicaid regulations which directly affect the way the Oklahoma Health Care Authority (OHCA) enforces accountability.

The OHCA  may terminate a contract with or without cause, as well as immediately upon evidence of fraud or if the provider’s license or certification is modified, suspended, revoked or terminated.

Medicaid Regulations: 42 C.F.R. § 455.23

“The State Medicaid Agency must suspend all Medicaid payments to a provider after the agency determines there is a credible allegation of fraud.”

A credible allegation of fraud may be an allegation which has been verified by the State, from any source. Allegations are considered to be credible when they have an indicia of reliability.

This increased activity is due to an increase in quality control activity, new federal regulatory guidance, and an increase in the agency’s ability to data mine. The OHCA  has better tools for finding fraud, or something that looks like fraud, which in turn gives them the authority to terminate and ask questions later.

“The OrionNet Systems’ software is designed to help you [agencies] prevent these kind of incidences. We also have a great support team ready to help with anything you have issues with.,” Clyde Wafford said.

For More Information:

Are you in Compliance!