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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/31/16

Reissue of Chapter D-200, Handbook for Providers of Encounter Clinic Services

 

To: Federally Qualified Health Centers, Rural Health Clinics and Encounter Rate Clinics
Date March 31, 2016
Re: Reissue of Chapter D-200, Handbook for Providers of Encounter Clinic Services

The Department is reissuing the Chapter D-200, Handbook for Providers of Encounter Clinic Services. No changes have been made to the Department’s coverage or billing policies for encounter rate clinics; but due to the number of pages with revisions, a reissue of the handbook is more efficient for both the Department and providers. The topics that have been clarified in this reissue are summarized below:

  • Topic D-200, Basic Provisions: clarification that the billing instructions in the handbook do not apply to participants enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs).
  • Topic D-201, Provider Enrollment: changes made to reflect the enrollment process under IMPACT, the Department’s new web-based enrollment system.
  • Topic D-202, Encounter Clinic Reimbursement: clarification that the billing instructions in the handbook do not apply to participants enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs).
  • Topic D-203, Covered Services: clarification on covered services for encounter clinics. 
  • Topic D-204, Non-Covered Services: clarification when services are considered to be a component of a billable encounter.
  • Topic D-210, General Limitations and Considerations on Covered Services: clarification on the billing of non-physician wellness services; billing of group psychotherapy services; billing of tobacco cessation counseling, and; allowable fee-for-service billing.
  • Topic D-214, Clarification of cost reporting.
  • Topic D-216, Rate Setting: changes made to reflect the annual Medicare Economic Index (MEI) adjustment made to the baseline encounter rates.
  • Appendix D-4, Explanation of Information on Provider Information Sheet: changes made to reflect the enrollment process under IMPACT.
  • Appendix D-5, Internet Quick Reference Guide: Internet links have been updated.

 

Any questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood
Director