When the second phase of a new claims processing system took effect in 2015 at the Mississippi Division of Medicaid (DOM), like any complex computer program it had some bugs that needed to be worked out. In this case, the error in the system related to reimbursable outpatient services that qualify for date bundling – grouping together multiple visits to a health-care provider for what is considered a single service, like physical therapy.
However, fixing that glitch in the system is only part of the problem. The other challenge is teaching providers about DOM’s policy regarding date bundling to bill their claims correctly, which is why Zeddie Parker, director of Hospital Programs and Services at DOM, and her team aims to provide outreach and training.
On Sept. 1, 2012, DOM changed its payment methodology for outpatient services from a cost-to-charge ratio payment to an Outpatient Prospective Payment System (OPPS) where each claim must be billed with a procedure code associated with it.
Under the prior system, a procedure code did not always have to be present in order to receive a payment. OPPS is designed to be a more accurate representation of what specific services are being billed for and paid.
On July 1, 2015, phase two of OPPS implementation went into effect, which included date bundling. Typically, all outpatient services provided by the same hospital to the same beneficiary on the same date should be billed on the same claim.
“However we’re going to allow multiple days for certain things like therapy, because we know that it’s going to continue for a span of dates,” Parker said. “Physical therapy is an outpatient service, but it’s something you would do continuously until you’re better, so we allow providers to bill up to 31 days for those types of services that are eligible for date bundling.”
After going live last year, it was determined that the system has been denying against single-day claims, which it’s not supposed to do. It should deny against span-date claims, which are multiple dates.
Working with the agency’s fiscal agent, Xerox, the system has been fixed and the process for a mass adjustment began Aug. 22. Parker has requested that Xerox provide DOM a list of all claims affected by the system between July 1, 2015, and Aug. 22, 2016, for review and approval to proceed with reprocessing these claims. Claims with dates of service beginning Aug. 22 forward are being processed correctly.
Some of those claims that are reprocessed may still be denied, Parker pointed out, because they weren’t billed correctly by the provider, hence the need for training.
“I want to give providers as much information as possible,” she said. “I want to define what date bundling is, identify services DOM considers date bundling and how they are recognized. I also want to explain how many days you can date bundle these services.
“For instance Medicare allows certain services for date bundling that DOM does not recognize, so we want to make that distinction very clear.”
Parker is working with the Office of Client Relations to coordinate training seminars throughout the fall. Trainings have been set for the following dates and locations:
- Oct. 25 – North Mississippi: Southaven
Registration: 8:30-9 a.m.
Training: 9 a.m. – 12 p.m.
Hilton Garden Inn
6671 Towne Center Loop
Southaven, MS 38671 - Nov. 2 – South Mississippi: Biloxi/Gulfport
Registration: 8:30-9 a.m.
Training: 9 a.m. – 12 p.m.
Courtyard Marriot
1600 East Beach Boulevard
Gulfport, MS 39501 - Nov. 8 – Central Mississippi, Jackson
Registration: 8:30-9 a.m.
Training: 9 a.m. – 12 p.m.
Central High School Auditorium
359 North West Street
Jackson, MS 39201
How to register for an OPPS training
To register for a training, please RSVP by emailing Provider Field Service Representative LaShundra Othello at Lashundra.Othello@conduent.com with the following information:
- Full name
- Title
- Facility name
- Contact phone number
- Number of participants
Reference guides and other resources will be available on the DOM website as they become available. For more information about OPPS, visit the Finance webpage.
For more information regarding OPPS Date Bundling contact Director of Hospital Programs and Servicers Zeddie Parker by email at zeddie.parker@medicaid.ms.gov or phone 601-359-2562.
