Provider Digest | Issue 36

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2024 CBI workshop recording + updates on Home Health Services rates

2024 Care-Based Incentive workshop recording now available

Last month, the Alliance hosted our annual Care-Based Incentive (CBI) workshop. The workshop covered changes in the upcoming 2024 CBI program as well as valuable tips and resources.

The 2024 CBI workshop recording is now available on our website. The webpage also includes the CBI 2024 Workbook, webinar slides and FAQs. Office staff and providers are encouraged to watch this recording and review the material from the workshop. If you have any questions or would like to schedule a training or CBI forensics visit, please reach out to your Provider Relations Representative.

Adjustment of erroneously paid claims for Home Health Services

The Department of Health Care Services (DHCS) publishes the maximum reimbursement rates for Home Health Agencies (HHA) in the Home Health Agencies (HHA) Billing Codes and Reimbursement Rates section of the Medi-Cal Manual.

Effective retroactively, the rates for the impacted codes have been updated to align with the rates published in the Medi-Cal manual.

No action is required on your part. The Alliance will adjust affected claims. If the rate was increased, the adjustment is positive. If the rate was reduced, the adjustment is negative.

All contracted providers will continue to receive contracted rates.

Code Effective Dates of Service On or After
G0156 2/1/2021
G0162 2/1/2021
G0299 9/16/2022
G0300 9/16/2022

The recoveries are authorized under Welfare and Institutions Code (W&I Code), Section 14177, and California Code of Regulations (CCR), Title 22, Section 51458.1(a)(1). In addition, the W&I Code sections authorize the Alliance to offset overpayments against amounts due to a provider.

If the total amount due to a provider is not sufficient to offset the recovery, the negative balance will be subtracted from future Medi-Cal reimbursements.

If you disagree with these adjustments, you may submit a Provider Inquiry Form (PIF) within 365 days of the new RA date.

If you have questions about these adjustments, you can call the Alliance Claims Department at 831-430-5503, Monday through Friday from 8:30-11:30 a.m. and 12:30-4:30 p.m.