Gary,

 

In reference to a draft rule, our team was asked to participate in a DODD workgroup to determine the impact of this new add-on to billing processes and software. While we were not given a draft rule, I have attached notes we took while being part of the workgroup.

 

The proposal includes at least 16 new billing service codes for agency providers that will be used only when the staff providing the service qualifies for the new add-on.  Our team is currently making changes to Advisor’s Single-Entry module so that both billing and payroll can be calculated correctly after this add-on goes into effect.   

 

In the process of making updates to Advisor, our team has become aware of how unique this add-on is compared to those we’ve seen in the past. It presents some particular challenges when trying to bill.

 

The $0.39 per unit add-on will not be part of the individual’s budget and, instead, is paid through a different funding stream. Recording these funds separately is important for providers who monitor utilization.

 

Another challenge we’re anticipating is when providers have a mix of eligible and non-eligible staff providing services at the same time. In the past, we’ve relied on the codes to indicate staff size. We’ve heard we’ll need to be entering the number of staff who qualify for the add-on for these new codes, which will cause a change in the process for billing staff.

 

The Advisor updates that we’re developing will address both of these challenges in time for the July 1, 2018 effective date. It is our belief that DODD is expressing confidence in their effective date because of their on-going and long-term conversation with CMS about this incentive.

 

Our team is working on some future training events around this add-on, and we’ll be happy to share the details of those with OPRA members.

 

Thanks,

 

 

 

It is my understanding that this amendment to the waiver has not been approved by CMS yet. My question is, before everyone tries to figure this out on their own, has DODD shared any “draft” rule language governing the billing and payment of this yet?

 

 

 

Members,

 

Below is a question from another member on how agencies are thinking about implementing the competency based add-on for their staff.

 

“We were discussing the DSP incentive money and every time we do everything we come up with on how to deal with it in billing and payroll is looking like a nightmare.  I guess what I would like is how other providers are planning on dealing with this...”

 

Thanks!

 

Have a great weekend!

 

Christine

 

Christine Touvelle

Policy Analyst

Ohio Provider Resource Association

C- 513-543-4131

1152 Goodale Blvd.

Columbus, Ohio 43212

 

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