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Kansas Medical Assistance Program Provider Manual

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KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Professional PART II PROFESSIONAL SERVICES PROVIDER MANUAL Section Page INTRODUCTION BILLING INSTRUCTIONS 7000 CMS-1500 Billing Instructions ......... ......... ......... ......... ........ 7-1 Submission of Claim Form .... ......... ......... ......... ........ 7-7 7010 Specific Billing Information ... ......... ......... ......... ......... ........ 7-8 BENEFITS AND LIMITATIONS 8100 Copayment ............ ......... ......... ......... ......... ......... ........ 8-1 8200 Reserved for Future Use ...... ......... ......... ......... ......... ........ 8-1 8300 Benefit Plans .......... ......... ......... ......... ......... ......... ........ 8-2 8400 Medicaid Program Overview . ......... ......... ......... ......... ........ 8-3 Abortion ...... ......... ......... ......... ......... ......... ........ 8-3 ACH Services ......... ......... ......... ......... ......... ........ 8-4 Ambulance ... ......... ......... ......... ......... ......... ........ 8-5 Apnea Monitors ....... ......... ......... ......... ......... ........ 8-6 Audiology .... ......... ......... ......... ......... ......... ........ 8-7 Cardiac Rehabilitation. ......... ......... ......... ......... ........ 8-8 Children and Family Services Contractors ...... ......... ........ 8-9 CMHC ........ ......... ......... ......... ......... ......... ........ 8-9 Consultations . ......... ......... ......... ......... ......... ........ 8-9 CPAP . ........ ......... ......... ......... ......... ......... ........ 8-9 Dental ........ ......... ......... ......... ......... ......... ........ 8-9 Developmental Testing. ........ ......... ......... ......... ........ 8-10 Dietitian Services ...... ......... ......... ......... ......... ........ 8-10 Documentation ......... ......... ......... ......... ......... ........ 8-10 DME . ........ ......... ......... ......... ......... ......... ........ 8-11 EKGs . ........ ......... ......... ......... ......... ......... ........ 8-11 Emergency Services for Aliens ......... ......... ......... ........ 8-12 Family Planning ....... ......... ......... ......... ......... ........ 8-12 Hospice ........ ......... ......... ......... ......... ......... ........ 8-13 Hospital ....... ......... ......... ......... ......... ......... ........ 8-13 Hyperbaric Oxygen Therapy... ......... ......... ......... ........ 8-21 Immunizations ......... ......... ......... ......... ......... ........ 8-22 Injections ..... ......... ......... ......... ......... ......... ........ 8-22 Intrathecal Baclofen Pump...... ......... ......... ......... ........ 8-22 Laboratory .... ......... ......... ......... ......... ......... ........ 8-22 LEA Services ......... ......... ......... ......... ......... ........ 8-24 Maternity Center Services ..... ......... ......... ......... ........ 8-24 Mid-Level Practitioners ........ ......... ......... ......... ........ 8-24 Nursing Facility ....... ......... ......... ......... ......... ........ 8-24 OB/Gynecological ..... ......... ......... ......... ......... ........ 8-24 OB Sonograms ......... ......... ......... ......... ......... ........ 8-26 Office Visits .. ......... ......... ......... ......... ......... ........ 8-26 Oxygen Therapy ....... ......... ......... ......... ......... ........ 8-26 Pain Management ..... ......... ......... ......... ......... ........ 8-27 Patient Demand Cardiac Monitoring ... ......... ......... ........ 8-30 Section 8400 (cont.) Pharmacy .............. ......... ......... ......... ......... ........ 8-31 Prosthetic and Orthotic Devices ................. ......... ........ 8-34 Psychiatric ............. ......... ......... ......... ......... ........ 8-35 Radiology ..... ......... ......... ......... ......... ......... ........ 8-36 Renal Dialysis/Kidney Transplants .... ......... ......... ........ 8-40 Sterilizations .......... ......... ......... ......... ......... ........ 8-41 Surgery ........ ......... ......... ......... ......... ......... ........ 8-44 Therapy (Rehabilitative) ....... ......... ......... ......... ........ 8-45 Transplants .... ......... ......... ......... ......... ......... ........ 8-47 Tuberculosis .. ......... ......... ......... ......... ......... ........ 8-47 Vagal Nerve Stimulators........ ......... ......... ......... ........ 8-48 Vision . ........ ......... ......... ......... ......... ......... ........ 8-48 Vacuum Assisted Wound Closure Therapy .... ......... ........ 8-48 Section ARNP 8410 Anesthesia ............. ......... ......... ......... ......... ........ 8-49 Case Management ..... ......... ......... ......... ......... ........ 8-49 Pain Management ..... ......... ......... ......... ......... ........ 8-50 TA Children's Waiver ......... ......... ......... ......... ........ 8-53 ARNP Procedure Codes ....... ......... ......... ......... ........ 8-54 Section LOCAL HEALTH DEPARTMENT 8420 Family Planning ................ ......... ......... ......... ........ 8-55 Skilled Nursing Services ....... ......... ......... ......... ........ 8-55 Prenatal Health Promotion and Risk Reduction (PHP/RR) .... 8-55 Prenatal Health Promotion/Risk Reduction High Risk Nutrition Services (PHP/RRHRN) .. ........ 8-57 Prenatal Health Promotion/Risk Reduction Enhanced Social Work Services (PHP/RRESW) ........ 8-58 Postpartum/Newborn Home Visit (PP/NBHV) ......... ........ 8-59 Dental Services ......... ......... ......... ......... ......... ........ 8-60 Local Health Procedure Codes ......... ......... ......... ........ 8-61 Section KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT 8430 STATE LABORATORY ...... ......... ......... ......... ........ 8-62 Appendices Procedure Codes and Nomenclature .. ......... ......... ......... ......... ......... ........ Appendix I Minor Surgery/Outpatient Surgery - Procedure Codes and Nomenclature ...... ........ Appendix II Forms Abortion Necessity Form CMS-1500 Hearing Aid Necessity Home Monitor Information Home Oxygen Information Hysterectomy Consent Form NDC Detail Attachment Form Sterilization Consent Form (English) & Sterilization Consent Form (Spanish) Instructions for the Sterilization Form PART II PROFESSIONAL SERVICES Updated 05/07 This is the provider specific section of the manual. Part II was designed to provide information and instructions specific to professional services providers. It is divided into four subsections: Billing Instructions, Benefits and Limitations, Appendices, and Forms. Billing Instructions contains instructions on completion and submission of the HCFA-1500 CMS-1500 claim for paper billers. Benefits and Limitations defines specific aspects of the scope of services covered within the Kansas Medical Assistance Program (KMAP). The Appendix contains information concerning procedure codes. These appendices were developed to make finding and using procedure codes easier for the biller. Forms contains forms specific to providers of professional services. These forms may be duplicated for your use. Nonspecific forms (e.g., Prior Authorization, Medical Necessity) are located in Part I of this provider manual. HIPAA Compliance As a KMAP participant, providers are required to comply with compliance reviews and complaint investigations conducted by the Secretary of the Department of Health and Human Services as part of the Health Insurance Portability and Accountability Act (HIPAA) in accordance with section 45 of the code of regulations parts 160 and 164. Providers are required to furnish the Department of Health and Human Services all information required by the Department during its review and investigation. The provider is required to provide the same forms of access to records to the Medicaid Fraud and Abuse Division of the Kansas Attorney General's Office upon request from such office as required by K.S.A. 21-3853 and amendments thereto. A provider who receives such a request for access to or inspection of documents and records must promptly and reasonably comply with access to the records and facility at reasonable times and places. A provider must not obstruct any audit, review or investigation, including the relevant questioning of employees of the provider. The provider shall not charge a fee for retrieving and copying documents and records related to compliance reviews and complaint investigations. KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL INTRODUCTION BILLING INSTRUCTIONS 7000. Updated 02/08 THE CMS-1500 CLAIM FORM Providers of professional services must use the CMS-1500 red claim form (unless submitting electronically) when requesting payment for medical services and supplies provided under the Kansas Medical Assistance Program. Any CMS-1500 claim form not submitted on the red claim form will be returned to the provider. An example of the CMS-1500 claim form is in the forms section at the end of this manual. Instructions for completing this form are included on the following pages. Any of the following billing errors may cause a CMS-1500 claim to deny or be sent back to the provider: • The Kansas MMIS uses electronic imaging and optical character recognition (OCR) equipment. Therefore, information is not recognized if not submitted in the correct fields as instructed. Claim information must be submitted in the correct fields as instructed. • Staples on the claim form. • A CMS-1500 claim form carbon copy. The fiscal agent, EDS, does not furnish the CMS-1500 claim form to providers. Refer to Section 1100 of the General Introduction Provider Manual. Complete
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