Kentucky Medicaid - Kymmis.com

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FAQ’s Cont. Physicans ONLY • Recently the Department for Medicaid Services (DMS) requested a review of the medical necessity of CT scans performed for Medicaid members. The review revealed that many diagnoses appear unrelated to the medical conditions/reasons for CT scans. Inaccurate diagnosis coding may result in the denial or recovery of services because the medical necessity of the scan can not be determined. Medicaid funds can only be used for services that are medically necessary. • Examples of inappropriate brain CT diagnoses include cellulitis of the toe, sunburn, osteoarthritis, lumbago, trigger finger, joint pain of the shoulder, cough, chest pain, screening mammogram, removal of sutures, varied fractures and sprains of the patella, wrist, tibia, fibula, hand and foot. • Examples of inappropriate spine CT diagnoses include malaise, convulsions, generalized pain, altered mental status, abdominal pain, ankle and foot fractures and sprained ankle. • Examples of inappropriate chest CT diagnoses include panic disorder, anxiety, hyperlipidemia, appendicitis, pain in the limb, memory loss, headache and diarrhea. • DMS is requesting all providers review their radiology billing process and bill claims with the appropriate diagnoses that supports the medical necessity of the procedure being performed. Future restrictions may be imposed if the medical necessity of CT scans continues to be unsupported by the diagnosis codes. Cabinet for Health and Family Services 30
Did You Know * Coming Soon--Paper checks are going to be mailed from the KY State Treasurer. Remittance Advices will continued to be mailed by EDS. * GO GREEN--Did you know that you can opt not to receive paper RA's. You can download the RA from the KyHealth Net and keep an electronic copy. Cabinet for Health and Family Services 31
Page 1 and 2: Kentucky Medicaid Spring 2009 Billi
Page 3 and 4: Representative List Cabinet for Hea
Page 5 and 6: Reference List Helpful Phone Number
Page 7 and 8: Required Information FIELD NUMBER N
Page 9 and 10: Bottom Half of CMS Claim Form Cabin
Page 15 and 16: Forms • Third Party Liability •
Page 17 and 18: TPL Helpful Hints • When to use t
Page 19 and 20: Adjustment, Claim Credit/Void Hints
Page 21 and 22: Cash Refund Hints The Cash Refund D
Page 23 and 24: Timely Filing Examples 1 Year From
Page 25 and 26: Timely Filing Examples KyHealth Net
Page 27 and 28: FAQ’s If you bill Medicare and d
Page 29: FAQ’S Cont. Internal Control Num
Page 33: KY MMIS Project Provider Evaluation

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