FOCUS | ISSUE 6 | 2010

Update: MDA assists members responding to recent MO HealthNet self-audit requests

While we realize not all MDA members are MO HealthNet (Medicaid) providers, we believe it’s important to apprise all doctors of the follow- ing circumstances, as an example of just one of the many regulatory issues MDA monitors and advocates on for its members.

In an August enews and in the last Focus, we shared with members that the MO Health- Net (Medicaid) Program’s Integrity Unit had requested its dental providers to conduct self audits based on a “Dental Dashboard” project. Through the project, MO HealthNet identified various billing errors by providers through a review by an outside contractor. Since that time, MDA has been in conversations with members and MO HealthNet to gain a better understanding of the “egregious” mistakes MO HealthNet had identified and provided mem- bers notice of.

At the end of October, we sent an additional enews to provide an update on MDA efforts since becoming aware of the requests for self

audits, and provided members with prepared language for members wishing to respond to the audit requests (from MDA legal counsel).

On November 22, representatives of the MDA and the Missouri Primary Care Association met with representatives of the MO HealthNet Divi- sion and the Department of Social Services, in- cluding the Division Director, Dr. Ian McCaslin, regarding concerns about the MO HealthNet audits. MDA member dentists along with MDA legal counsel, Mr. Harvey Tettlebaum, and ADA Council on Dental Benefit Program Director, Dr. Dave Preble provided information to the Department representatives on the various issues and concerns surrounding the auditing, current adjudication of claims processes, and the unintended effects both could have.

The Department agreed to review the vari- ous policies and processes and work with the Dental Medicaid Advisory Committee in a ready fashion to resolve the matters of concern with both the policies and the auditing process. The

Department assured both Associations they would make this review a top priority, but could not provide us with an exact timeline.

As stated, MDA legal counsel had previously made available to members suggested response letters. Many, if not most, of the dentists already have used these letters to respond to their audits within the 60-day timeline.

If you have not responded yet, it is still MDA’s recommendation that members respond to the department’s audit letter in writing. Members can use one of the written responses that can be found online (link following) while the Department is conducting its review. We will notify you of the results of the review and recommended next steps as quickly as possible.

If you wish to send one of these letters, you may download at www.modental.org/docs/ communications/enewsdownloads/MHN_au- dit_sample_letters_102210.DOC, or contact the MDA and we can email these to you.

New MO HealthNet provider bulletin available online

A new Provider Bulletin was released November 10, 2010 titled “Physician/Dental: Topical Fluoride Var- nish Policy” (Vol. 33, No. 20). It is available at the MO HealthNet website: www.dss.mo.gov/mhd/ providers/pdf/bulletin33-20_2010nov10.pdf.

The MO HealthNet Physician/Dental Bulletin: Volume 31, Number 17 dated September 24, 2008, established coverage for the application of topical fluoride varnish (D1206) by physicians and nurse practitioners. The purpose of this bulletin is to clarify that medical professionals (RN, LPN, Physician Assistant) working in a physician’s office or clinic may apply topical fluoride varnish to MO HealthNet participants after receiving training in the application of topical fluoride varnish.

Additional bulletin contents include topical fluoride varnish services and application training, as well as billing topical fluoride varnish.

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