Miscellaneous Issues / Questions

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Miscellaneous Issues / Questions

• Jim Flowers / Roger Barnes / Chuck Smith, CPA
• DMA / Clifton Gunderson LLP
• November 9, 2006

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Certified Registered Nurse Anesthetists (CRNAs)

• CRNAs are reimbursed based on a fee schedule as
  incident to provider services prior to 1995 and
  allowed for direct enrollment and billing in
  1995.
• Fees for certified registered nurse anesthetists
  (CRNAs) are established at 90 of Anesthesiology
  rates. For DMA approved procedures (CPT and
  HCPCS) CRNAs will be reimbursed the same as
  physician services, which are based on the
  current Physician Medicaid Fee Schedule.
• NC State Plan, Attachment 4.19-B, Section 17,
  Page 1, (17B) effective 6/1/1995. TN 95-13

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Certified Registered Nurse Anesthetists (CRNAs)

• Costs and charges for Professional Services,
  including CRNAs must be excluded from the
  Medicaid cost report.
• Charges for non-covered services and services
  not reimbursed under the inpatient DRG
  methodology (such as professional fees) shall be
  deducted from total billed charges.
• NC State Plan, Attachment 4.19-A, Page 5, Section
  (g)(2). TN 05-015. Same language dates back to
  TN 94-33 effective 10/1/1995

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Certified Registered Nurse Anesthetists (CRNAs)

• Reminder of Medicaid policy is identified on the
  DMA website and cost report filing instructions.
• Professional fees may not be included in the 2552
  cost reports used to support the current DSH
  plan this was a component requirement of CMS
  approval.

5
Changing Allocation Basis

• Medicaid cost reports are filed independently
  from Medicare cost reports as evidenced by DMA
  direction in FY2004 and FY2005 to file cost
  reports in absence of delayed Medicare PSRs.
• Providers requesting to change an allocation
  basis in their Medicaid cost report shall follow
  guidance outlined in the Provider Reimbursement
  Manual (CMS 15-1), Chapter 23 and submit the
  request to DMA.

6
Changing Cost Report Period

• Although less common than a request to change an
  allocation basis, providers requesting to change
  their cost report period for their Medicaid cost
  report shall follow guidance outlined in the
  Provider Reimbursement Manual (CMS 15-1), Chapter
  24 and submit the request to DMA.

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Zero Paid Claims

• Currently Zero Paid Claims are excluded from
  charges and payments in calculation of outpatient
  settlements as well as desk reviews and field
  audits.
• To exclude Zero Paid Claims precludes the risk of
  private or non-Medicaid payments in excess of
  cost being applied to Medicaid recipient costs in
  cost settlement.

8
Critical Access Hospitals

• Effective with State Plan Amendment 05-015, with
  the effective date of 10/1/2005, Critical Access
  Hospitals will be settled to 100 of reasonable
  and allowable costs in accordance with North
  Carolina State Plan and the Provider
  Reimbursement Manual (CMS 15-1)

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Critical Access Hospitals

• SPA 05-015 for DSH Supplemental Payments
  changed cash flow for CAH.
• Interim (quarterly) cost reports will not be
  filed.
• Outpatient Services Ratio of Costs to Charges has
  been changed to 97.
• DMA will perform a tentative settlement based on
  the annual filed cost reports subject to a 10
  retainage pending a full scope field audit.
• Collection / Recoupments of payments in excess of
  costs will follow DHHS Cash Management Plan.
• Clifton Gunderson LLP contract Year 5 will
  perform full scope field audits on all public
  hospitals claimed for CPE and on all CAHs.

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Regulatory Guidance

• Medicaid Participation Agreement
• Comply with federal and state laws, regulations,
  state reimbursement plan and policies governing
  the services authorized under the Medicaid
  Program and this agreement (including, but not
  limited to, Medicaid provider manuals and
  Medicaid bulletins published by the Division of
  Medical Assistance and/or its fiscal agent).
• North Carolina State Plan
• Provider Reimbursement Manual

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QUESTIONS ?