What are you doing this summer? Planning a trip? Relaxing by the pool? Just going to keep working?
That all sounds good.
But if you or your practice orders or refers for Medicaid patients — even if you do not otherwise participate in Medicaid — here’s something you better do: Enroll in Medicaid before Oct. 1.
If you already have a Medicaid provider number or have already enrolled as an ordering and referring-only practice, you’re way ahead of the game. Go kick up your feet.
If you haven’t, you’d better get on it — Enrollment is required under the Affordable Care Act, and Oct. 1 will be here before you know it.
Enrollment applies to physicians, advanced practice registered nurses, physician assistants, and other health professionals and providers — anybody in your practice who orders or refers for Medicaid patients.
It also applies to physicians who only care for dual-eligible patients — those who are eligible for Medicare and Medicaid — and who order Medicaid-only services for those patients (the requirement does not apply to crossover claims). If that’s you, you must enroll as an ordering and referring physician.
“Good to know, but how do I enroll?” you ask? Click on the Texas Medicaid and Healthcare Partnership (TMHP) website. It’ll give you way more information than I can here.
Now, if you’re a physician whose only relationship with Texas Medicaid is to order or refer services to Medicaid clients, TMHP has developed an abbreviated enrollment application, which you can find here.
But wait, there’s more. There always is, isn’t there?
If you’re submitting a claim for services that require an order or a referral, you must include the National Provider Identifier (NPI) of the ordering, prescribing, or referring provider on the claim.
Furthermore, residents and interns at your practice will be able to order and refer using the supervising physician’s NPI, or they can use their own if they have one.
Very importantly, after Oct. 1, Medicaid patients who attempt to fill a prescription will be unable to do so if the ordering and referring physician or provider is not enrolled. Other examples of services that require an order or referral include:
- Clinical, radiological, or laboratory services;
- Home health agency services;
- Durable medical equipment (DME);
- Eyeglasses; and
- Hearing aids.
The requirement applies to whether a patient is enrolled in Medicaid managed care or fee-for-service.
So now you know. Enroll now so you can have a beach umbrella hanging over your head this summer instead of a deadline.
If you have questions about any of this, call TMHP at (800) 925-9126.
You’re welcome. We were thinking about you.
We knew you’ve been looking high and low for a comprehensive set of educational tools to help you figure out the MACRA Quality Payment Program (QPP) payment rules for the new pathways: the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs).
(By the way, MACRA = the Medicare Access and CHIP Reauthorization Act of 2015.)
So when the Physicians Advocacy Institute (PAI), in collaboration with health care consulting firm Healthsperien, asked us to work closely with them and other state medical associations to create a free MACRA Quality Payment Program (QPP) education initiative, we jumped at the chance. (TMA is a charter member of the PAI.)
Earlier this month, that resource center went live online. It includes:
- Recorded webinar tutorials available on-demand at your convenience;
- Summary and in-depth information on all aspects of the QPP, including a guide to acronyms, a guide to reporting mechanisms, and an explanation of how the QPP affects Medicare Part B payments;
- A step-by-step guide for physicians on how to navigate the QPP’s MIPS and APM pathways; and
- A searchable Frequently Asked Questions section.
“PAI is sharing this comprehensive array of resources free of charge to help any physician practice, regardless of its level of readiness or knowledge, assess its preparedness and determine the best approach to succeed under the MACRA QPP payment rules,” PAI said in a statement.
So click around, get lost in it, find out what you need to know.
And don’t forget about the TMA MACRA Resource Center. It’s just one of the ways TMA will continue to update you with the latest information to help you succeed in the QPP.