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June 27, 2008
HFS Provider Releases Summary
The entire notice may be found at either of the following links:
http://www.hfs.illinois.gov/hospitals/
http://www.hfs.illinois.gov/all/
Tamper Resistant Prescription Pads, March 14, 2008
This notice was a reminder that effective April 1, 2008 all non-electronic
Medicaid prescriptions are written on tamper-resistant prescription pads. This
could affect your hospital if your hospital provides prescription pads for
physician use in the emergency room.
Changes to Cost Outlier Payment Calculation, March 28, 2008
The purpose of this bulletin was to advise hospitals of changes in the cost
outlier payment calculation, and a new policy regarding outlier payments to
children’s hospitals effective with admissions occurring on or after January 1,
2008. For DRG reimbursed hospitals the specific fixed loss threshold used in the
cost outlier payment calculation will be multiplied by 1.64. For per diem
reimbursed hospitals a marginal cost payment factor of0.17 will be used in the
outlier calculation. Free standing children’s hospitals are now eligible to
receive outlier on claims for children through the age of 18.
Timely Filing of Medicare/Medicaid Crossover Claims, March 31, 2008
This notice was to inform providers of the department’s policy for timely
filing of Medicare/Medicaid Crossover Claims. If these types of claims are not
submitted to HFS within two years of the date of service the claim will be
rejected. This may affect your hospital’s disproportionate share
(DSH) calculation if these days are not included in the determination. It
is important to bill all Medicare/Medicaid crossover claims in the future within
the two year time frame if you want the days included in DSH calculation.
Rate Year 2009 DSH and CHAP Determination, April 10, 2008
This notice was a reminder for hospitals to submit information used in the
DSH calculation. Information that has to be received are postmarked by July 1,
2008 include The obstetrical statement, revised unaudited cost reports,
verification of out of state Medicaid recipients utilization and the low income
utilization collection form with and audited financial statement. The OBRA’93
data collection form is required by August 15, 2008.
Attachment C Utilization Review Update for June 1, 2008, May 1, 2008
This notice provides deletions and additions to diagnosis codes on
Attachment C subject to admission/concurrent inpatient utilization review. It
also contained a reminder of the department’s policy regarding 4th
and 5th digit codes subject to utilization review activities. When a
diagnosis code is subject to review and the ICD-9-CM coding guidelines mandate a
coding change requiring a 4th or 5th digit code extension,
the 4th and 5th digit extension will automatically be
subject to review.
New Eligibility Messages, May 9, 2008
This notice was to inform providers of two new eligibility messages being
reported on the MEDI system. The messages indicate if a hospital should bill HFS
or DHS for psychiatric services.
Update of Covered Renal Dialysis Injectable Drugs, June 11, 2008
The department currently allows an add-on payment for certain injectable
drugs billed on institutional outpatient renal dialysis claims. Effective with
dates of service on or after April 1, 2008 the Department will provide
reimbursement for HCPCS Q4098 – Injection, Iron Dextran, 50mg. Effective with
dates of service on or after April 1, 2008 the following HCPCS codes are
obsolete and will no longer be reimbursable: J1751 – Injection, Iron Dextran
165, 50mg and J1752 – Injection, Iron Dextran 267, 50mg.
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