A long time dental Medicaid provider recently sent to TDMR an old article that was written in the March/April 2005 edition of the Texas Medicaid Bulletin. It is interesting because both the Texas Medicaid and Health Partnership (TMHP) and the Texas Health and Human Services Office of the Inspector General (HHSC-OIG) were supposed to start educating Medicaid providers on issues relating to problematic billing practices back at that time. Apparently that education never occurred.
It can be rightly pointed out in relation to dental and orthodontic Medicaid billing, HHSC-OIG had the opportunity to utilize the Texas Medicaid Bulletin to inform dental providers of problems in the billing area and the 2008 audit of TMHP which showed deficiencies in TMHP’s orthodontic pre-approval process. As the article states: “As common patterns of misuse become known and addressed, a greater accessibility to that information will serve to help providers appropriately hill for Medicaid services.”
Here is the text of the article:
Ofﬁce of Inspector General’s Provider Education
The HHSC Office of Inspector General (OIG) periodically uses the Texas Medicaid Bulletin to address provider education issues such as those indicating abnormal billing practices, quality of care patterns, potential areas of improvement, or to reinforce pertinent information from the Texas Medicaid Provider Procedure Manual, bulletins, and Explanation of Beneﬁts (EOBs).
Starring in May 2005, TMHP, in conjunction with the OIG, will begin a series of articles addressing provider education regarding common misuse trends. The articles will address Medicaid policy associated with the identiﬁed areas and how to appropriately bill related services. These articles also will cite related resources for more information.
According to Section 2.3, Medicare/Medicaid Fraud, Abuse Policy,” of the Texas Medicaid Procedure Manual, providers are responsible For maintaining a current understanding of the requirements For participation in the Texas Medicaid Program. These requirements include understanding current Medicaid policies and the associated billing practices.
The collective goal of OIG and TMHP is to enhance communication and understanding by making substantive information available to providers on a broader scale. As common patterns of misuse become known and addressed, a greater accessibility to that information will serve to help providers appropriately hill for Medicaid services.
The ﬁrst educational article will focus on counseling services and is scheduled to appear in the 2005 May/June Texas Medicaid Bulletin. Continue to refer to future bulletins for additional informational articles.