Practice Support Newsletter

July 2024

Measure of the Month: Prenatal and Postpartum Care (PPC)

NC Medicaid along with the Standard Plans and Tailored Plans, are focusing on improving prenatal and postpartum care. This measure has two facets of prenatal and postpartum care; they are: 

1. Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.
2. Postpartum Care. The percentage of deliveries that had a postpartum visit between 7 and 84 days after delivery.

For full measure specifications, please refer to the NC Medicaid Quality Measurement Technical Specifications (page 115) or/and HEDIS Measurement Technical Specifications (page 9). 

Strategies to help improve your prenatal and postpartum care measures:

• If you provide prenatal or postpartum care, utilize the new NC Medicaid F Codes refer to the Coding Corner in this month's Newsletter
• Facilitate rapid prenatal and postpartum appointments in your office
  – If your practice does not provide prenatal or postpartum care, build relationships with obstetricians for warm handoffs
• Utilize NC Notify to receive updates on recent admissions/discharges to schedule follow up appointments
• Work with a South Piedmont AHEC Practice Support Coach!

Coding Corner: Providers of Obstetrical Services Take Note of the Revised Policy!

There have been revisions to the 1E-5 Obstetrical Services Policy that could impact you! Starting April 1st, 2024, notable changes. CPT code 0500F (Initial Prenatal Care visit) is to be documented for the date of service when a pregnant beneficiary is seen and evaluated by an OB provider. This code is not to be used for any pregnancy confirmation visit prior to the initial assessment by the OB provider. CPT code 0503F (Postpartum Care Visit) is to be documented on claim line 1 at the postpartum visit. This applies to new and existing practice beneficiaries. Providers will have until July 1, 2025, to follow billing both 0500F and 0503F. After this date, claims for delivery will be denied if 0500F is not in the history in NCTracks. Global package claims will require 0500F on line 1 and delivery code on line 2 if not already submitted. 

For additional changes refer to the entire revised policy from NC Medicaid. 

Regulatory Reminders: 

Infection Control Training: It's the LAW

The North Carolina Administrative Code, 10A NCAC 41A .0206, requires every healthcare organization that performs invasive procedures (including injections) is required to designate an on-site staff person to receive infection control training and implement an infection control program. NC SPICE offers courses, in-person or online, to train the onsite staff person to meet the requirement. Additionally, NC SPICE has resources specific to the outpatient setting to include videos, templates, tool kits and checklists. 

FREE Webinar! The State of Adolescent Mental Health: Where we’ve been, where we are, and where we are going

While the COVID-19 pandemic highlighted critical trends in mental health among both adults and adolescents, bringing unprecedented attention to the accessibility of care, rates of these challenges among adolescents have actually been rising for over a decade. Through this lunch and learn, participants will explore trends in adolescent mental health over the past decade, what factors may be impacting the rise in concerns, and how they can help to create supportive environments and increase access to care. This free webinar is August 21st from 12 PM – 1 PM. To learn more and to register, please visit South Piedmont AHEC.

Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch

NC Medicaid is committed to ensuring our providers and members are supported at the launch of the Behavioral Health Intellectual/Developmental Disabilities (I/DDs) Tailored Plans, which will launch on July 1, 2024. A key priority at transition is to ensure NC Medicaid beneficiaries receive the care they need as scheduled, with no interruption, after launch on July 1, 2024. 

NC Medicaid has implemented flexibility related to prior authorizations, out of network rates, out of network rules and primary care changes. Additionally, Tailored Plans are required to support transitioning beneficiaries currently being treated by providers by honoring prior authorizations and paying claims for seven months post go-live. Please refer to the bulletin for the details.

Tailored Plan Communication Tools

On July 1, some people on NC Medicaid will move to a Tailored Plan. NC Medicaid has developed a toolkit to help beneficiaries navigate their resources. 

Check out these free materials, in Spanish and English, to learn more about resources offered with a Tailored Plan: Medicaid.NCDHHS.Gov/Tailored-Plans/Toolkit (English) Medicaid.NCDHHS.Gov/Tailored-Plans/Toolkit/es (Spanish). These resources include:   

• NEW! How to request rides to Medicaid-covered medical appointments with a Tailored Plan (download here). Descarga el contenido aquí.
• NEW! How to know if your doctor is participating in your plan, and what to do if they are not (download here). Descarga el contenido aquí.
• NEW! Guide about 1915(i) home and community-based services (download here). Descarga el contenido aquí.
• NEW! Shareable content about Tailored Plans that you can share on your social and digital channels (download here). Descarga el contenido aquí.
• What to do if your Medicaid will move to a Tailored Plan (visit the page here). Visita la página web aquí.
• What to expect and the services covered on your Tailored Plan (visit the page here). Visita la página web aquí.

Provider Ombudsman Issue Resolution Form

As a reminder, the Provider Ombudsman should be contacted when Medicaid practices are experiencing issues related to payment, clinical, claim denial, provider issue, etc. Provider Ombudsman inquiries, concerns or complaints can be directed to the Medicaid.ProviderOmbudsman@dhhs.nc.gov email distribution listserv address, or providers may utilize the Medicaid Manage Care Provider Ombudsman line at 919-527-6666. It is important to include all relevant information to help resolve the issue. We encourage practices to utilize our Provider Ombudsman Issue form to help format the information. If you need a fresh copy of the form, please contact your South Piedmont AHEC Coach.

South Piedmont AHEC Class Spotlight

Stop the Revolving Door: Recruiting and Retaining High-Performing Employees

Busy organizations have patients to see, claims to be processed, and work to be done. How does a healthcare leader recruit and retain high quality team members consistently… while maintaining financial responsibility? 

In this session, leaders will learn five keys to curating a culture that retains top talent and become a workplace that people seek out. An environment that draws new people in and invites them to stay is never just an accident. Leaders must intentionally decide to learn and leverage best practices. 

To learn more about this session and to register, visit South Piedmont AHEC. 

South Piedmont AHEC Practice Support – Helping you meet the challenges!

In this time of great transition in health care practices need to position themselves for new payment models, incentive programs, and other health care reforms while refocusing on patient-centered care. South Piedmont AHEC is currently able to provide these direct, individualized services at no cost.

Additional Resources: