KS Medicaid Fee Schedule: A Comprehensive Guide for Providers
Navigating the complexities of healthcare reimbursement can be daunting, especially when dealing with government programs like Medicaid. This comprehensive guide delves into the intricacies of the KS Medicaid fee schedule, providing you with the information you need to understand how reimbursements are calculated in Kansas. We'll explore key aspects, from finding the official schedule to understanding the different payment methodologies employed. Whether you're a seasoned healthcare provider or just starting out, this guide will equip you with the knowledge to effectively manage your billing and reimbursements under the Kansas Medicaid program.
Understanding the Kansas Medicaid Fee Schedule
The KS Medicaid fee schedule is a crucial document that dictates the maximum amount the Kansas Medicaid program will reimburse healthcare providers for specific services rendered to eligible beneficiaries. This schedule is not a static document; it's regularly updated to reflect changes in healthcare costs, policy adjustments, and market dynamics. It's essential for providers to stay abreast of these updates to ensure accurate billing and avoid potential payment delays or denials.
Accessing the Official KS Medicaid Fee Schedule
Locating the most up-to-date KS Medicaid fee schedule requires diligence. The Kansas Medicaid website is the primary source. Look for sections dedicated to providers, billing, and fee schedules. Often, these schedules are categorized by provider type (e.g., physicians, hospitals, therapists) and may be available in downloadable formats like PDF or Excel spreadsheets. You might need to navigate through several sub-pages, so be prepared to spend some time searching. If you're unable to locate the schedule online, contacting the Kansas Medicaid provider services directly via phone or email is recommended.
Key Components of the KS Medicaid Fee Schedule
The KS Medicaid fee schedule typically includes several key components:
HCPCS Codes: Healthcare Common Procedure Coding System (HCPCS) codes are used to identify specific medical services and procedures. The fee schedule lists the corresponding reimbursement rate for each code.
Reimbursement Rates: These are the maximum amounts the Kansas Medicaid program will pay for each service. These rates vary based on several factors, including the type of service, the provider's location (rural vs. urban), and the beneficiary's specific circumstances.
Payment Methodologies: Understanding how Kansas Medicaid calculates payments is critical. Common methodologies include fee-for-service (FFS), capitation, and prospective payment systems (PPS). Each has its own set of rules and calculations.
Modifiers: These are alphanumeric codes added to HCPCS codes to provide additional information about the service rendered. Modifiers can influence reimbursement amounts.
Navigating Different Payment Methodologies within the KS Medicaid Fee Schedule
As mentioned, the KS Medicaid fee schedule utilizes different payment methodologies. Let's examine some of the most common:
Fee-for-Service (FFS)
Under FFS, providers are reimbursed for each individual service provided to a Medicaid beneficiary. The reimbursement amount is determined by the specific HCPCS code and the applicable rate listed in the KS Medicaid fee schedule. This is a straightforward method but can lead to complexities in tracking and billing.
Capitation
In capitation, providers receive a fixed payment per member per month (PMPM) for each Medicaid beneficiary assigned to their care. This shifts the risk from the payer to the provider, incentivizing preventative care and efficient resource management. The PMPM rate is negotiated separately and isn't directly part of the published KS Medicaid fee schedule.
Prospective Payment Systems (PPS)
PPS is often used for hospital inpatient services. Reimbursement is based on pre-determined rates for specific diagnosis-related groups (DRGs). The complexity of the patient's case and the resources used are considered in assigning the DRG, influencing the final reimbursement. This method aims to incentivize efficient hospital care.
Staying Updated on Changes to the KS Medicaid Fee Schedule
The KS Medicaid fee schedule is subject to change. Regularly checking the Kansas Medicaid website for updates is crucial. Subscribe to email alerts or newsletters from the Kansas Medicaid agency to receive timely notifications about policy changes and updates to the fee schedule. Staying informed will ensure you maintain accurate billing practices and avoid costly errors.
Conclusion
Understanding the KS Medicaid fee schedule is vital for healthcare providers seeking to effectively bill and receive reimbursements for services rendered to Medicaid beneficiaries in Kansas. By familiarizing yourself with the schedule's components, accessing the official documents, and understanding the various payment methodologies, you can streamline your billing process and ensure your practice receives timely and accurate payments. Remember to always consult the official Kansas Medicaid website for the most up-to-date information.
FAQs
1. Where can I find the most current KS Medicaid fee schedule? The official Kansas Medicaid website is the primary source. Look for provider resources or billing sections.
2. How often does the KS Medicaid fee schedule update? The frequency of updates varies, but it's advisable to check regularly, ideally at least quarterly, for any modifications.
3. What if I can't find a specific HCPCS code in the fee schedule? Contact the Kansas Medicaid provider services for clarification or assistance in locating the correct code and reimbursement rate.
4. Are there any resources available to help me understand the different payment methodologies? Kansas Medicaid's provider services may offer training or educational materials explaining capitation, FFS, and PPS.
5. What should I do if I receive a payment that differs from what the fee schedule indicates? Contact Kansas Medicaid's provider services immediately to dispute the payment and provide documentation supporting your claim.
Microsoft Word - How to locate the Medicaid Fee Schedules
How to locate the Medicaid Fee Schedules. Outpatient. https://portal.kmap-state-ks.us/PublicPage. Click on Provider. Click on Interactive Tools. . Click. You are able to click on …
Table of Contents - Medicaid.gov
The agency’s fee schedule rate was set as of May 1, 2020 and is effective for TPN solutions provided on or after that date. The agency’s established fee schedule rates are published on …
Table of Contents State/Territory Name: KANSAS - Medicaid.gov
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Table of Contents State/Territory Name: Kansas - Medicaid.gov
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The agency’s fee schedule rate was set as of May 1, 2022 and is effective for services provided on or after that date. The agency’s established fee schedule rates are published on the …
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KANSAS-Medicaid-Covered-Codes. KANSAS-Medicaid-Covered-Codes Codes 0001U 0002U 0003U 0005U 0007U 0008U 0009U 00100 00102 00103 00104 0010U 0011M 0011U 00120 …
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The KS Medicaid fee schedule is a crucial document that dictates the maximum amount the Kansas Medicaid program will reimburse healthcare providers for specific services rendered to …
Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services
The Kansas Medicaid fee-for-service program reimburses for health care services in a number of different types of hospitals including: acute care, psychiatric, rehabilitative, and state institu-tions.
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Table of Contents State/Territory Name: Kansas - Medicaid.gov
The agency’s fee schedule rate was set as of May 1, 2020 and is effective for TPN solutions provided on or after that date. The agency’s established fee schedule rates are published on …
Kansas Medicaid - KHI
In state fiscal year (FY) 2021, Medicaid and CHIP covered an average of 461,090 people in Kansas per month at a cost of $4.4 billion for the year, as shown in Figure 1. Expenditures for …
Table of Contents State/Territory Name: Kansas - Medicaid.gov
Intensive Individual Supports are based upon a Medicaid fee schedule established by the State of Kansas. Commercial third-party payers and market rates will be considered when establishing …
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Real and Personal Property Fee Inflation 0.000% RPPF Rebase Add On RPPF Before Limit RPPF Limitation Allowable RPPF (4) $906,036€ $891,625€ $876,674€ ... 1st QTR Medicaid CMI: 1.0813 SAMPLE Rate Schedule. Title: Kansas Rate …
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Below is information related to eConsult codes as reimbursed by state Medicaid fee-for-service programs. On January 1, 2024, each state’s physician fee schedule was examined for the existence of the code. If a separate fee schedule existed for federally qualified health centers (FQHCs) it too was examined for these codes.
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Table of Contents - Medicaid.gov
Reimbursement for services is based upon a Medicaid fee schedule established by the State of Kansas. Effective January 1, 2022, additional varicose vein treatment modalities reimbursement rates ... the corresponding schedule; d. Click the schedule TXIX. KS 24-0009 Approval Date August 14, 2024 Effective Date 7/1/2024 Supersedes KS 24-0007 ...
KANSAS MEDICAID STATE PLAN - cdn.ymaws.com
KANSAS MEDICAID STATE PLAN . Attachment 4.19- B ... and click on the word “Accept” to access the fee schedule. The next page that appears is titled “KMAP ... the user will see a list of the current and historical versions of . the corresponding schedule; d. Click the schedule TXIX. KS 23-0043 Approval Date_____ Effective Date 1/1/2024 ...
Table of Contents - Medicaid.gov
Centers for Medicare & Medicaid Services 7500 Security Blvd Baltimore, Maryland 21244-1850 ... KS 23-0034 Approval Date:12/08/2023 Effective Date: 10/01/2023 Supersedes: New . ... agency's established fee schedule rates are published on the agency's website at
Table of Contents State/Territory Name: KANSAS
Topeka, KS 66612-1220 RE: TN 24-0018 Dear Medicaid Director Osterlund, The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed Kansas State Plan Amendment (SPA) to Attachment 4.19-B 24-0018, which was submitted to CMS on August 15, ... state developed fee schedule rates are the same for both governmental and private ...
Kansas Medicaid A Primer 2024 original document - KHI
MEDICAID AND CHIP SPENDING IN KANSAS. Medicaid and CHIP Spending . in Kansas. In Kansas, about one-quarter (23.0 percent) of all . Medicaid and CHIP enrollees are adults age 65 and . older or people with disabilities, but this combined . population incurs two-thirds (68.8 percent) of total state expenditures for the Medicaid and
Table of Contents - Medicaid.gov
Topeka, KS 66612-1220 RE: TN 24-0021 Dear Medicaid Director Osterlund, The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed Kansas State Plan Amendment (SPA) to Attachment 4.19-B 24-0021, which was submitted to CMS on October 4, ... state developed fee schedule rates are the same for both governmental and private ...
Kansas Medicaid Fee Schedule - wclc2018.iaslc.org
Jul 3, 2023 · Reimbursement for services are based upon a Medicaid fee schedule established by the State of Kansas. Effective January 1, 2022, additional varicose vein treatment modalities reimbursement rates ... KanCare & Medicaid | KDHE, KS - Kansas.gov Health services are purchased through either a managed care model or a fee-for-
Table of Contents State/Territory Name: Kansas - Medicaid.gov
Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106 ... KS 22-0012 Approval Date 6/21/22 Effective Date 5/1/22 ... Except as otherwise noted in the plan, state developed fee schedule rates are the same for both governmental and private providers for the above services. The agency’s fee schedule rate ...
Table of Contents State/Territory Name: Kansas State Plan …
Reimbursement for services are based upon a Medicaid fee schedule established by the State of Kansas. Effective January 1, 2022, additional varicose vein treatment modalities reimbursement rates ... the corresponding schedule; d. Click the schedule TXIX. KS 23-0003 Approval Date 1/18/2023 Effective Date 1/1/2023 Supersedes KS 22-0003 .
Kansas Medicaid Adult Dental coverage implemented July 1, …
Code Description Fee D1354 $15.00 D2140 Amalgam - one surface $53.50 D2150 Amalgam - two surfaces $64.00 D2160 Amalgam - three surfaces $76.00 D2161 Amalgam- four or more surfaces $91.50 ... Kansas Medicaid Adult Dental coverage implemented July 1, 2022 Link to Provider Bulletin 22140.
Chapter Durable Medical Chapter 4 - Kansas.gov
ongoing basis. This practice resulted in Medicaid paying thousands of dollars for a rental fee on a pump that cost $400 to purchase. The coverage policy was updated to allow purchase with prior authorization; renting is only allowed when it is evident that the need will be of short duration. If the need is lifetime, purchase is required.
Table of Contents State/Territory Name: KANSAS
Centers for Medicare & Medicaid Services Center for Medicaid & CHIP Services 230 South Dearborn Chicago, Illinois 60604 ... to Attachment 4.19-B KS-24-0011, which was submitted to CMS on August 2, 2024. This plan amendment updates the Global Pregnancy reimbursement rates. ... state-developed fee schedule rates are the same for both
Table of Contents State/Territory Name: KS State Plan …
costs are not included in the Medicaid fee schedule. Except as otherwise noted in the plan, state-developed fee schedule rates are the same for both governmental and private providers of EPSDT. The agency’s fee schedule rate was set as of August 16, 2019 and is effective for services provided on or after that date. Allrates are
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Centers for Medicare & Medicaid Services Center for Medicaid & CHIP Services 233 North Michigan Ave., Suite 600 Chicago, Illinois 60601 ... KS 66612-1220 RE: Kansas State Plan Amendment (SPA) ... state developed fee schedule rates are the same for both
Table of Contents State/Territory Name: KS State Plan …
Centers for Medicare & Medicaid Services . 7500 Security Boulevard, Mail Stop S2-26-12 . Baltimore, Maryland 21244-1850 ... KS 22-0026 Approval Date ESeptember 27, 2022 ... established fee schedule rates are published on the agency’s website at
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KY Medicaid Physician Fee Schedule 2023 Revised 1.9.2024 Procedure Code Procedure Description PA Ind Inpat Rate Facility Outpat Rate NonFacility Tech. Comp. Prof. Comp. Base Unit Value Notes 00100 ANES FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY * * 5.00
Table of Contents - Medicaid.gov
Centers for Medicare & Medicaid Se1vices 7500 Security Boulevard Baltimore, Maiyland 21244-1850 ... KS 23-0044 Approval Date: 2/23/2024 Effective Date: 1/1/2024 Supersedes: New . ... agency’s established fee schedule rates are published on the agency’s website at
Table of Contents State/Territory Name: KS State Plan …
Centers for Medicare & Medicaid Services . 7500 Security Boulevard, Mail Stop S2-26-12 . Baltimore, Maryland 21244-1850 ... based upon 85% of the current Medicare fee schedule rates when billed separately for ... KS 23-0006 Approval Date March 1, 2023 Effective Date 1/1/2023 Supersedes KS 13-01 ...
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2009 Medicaid Transformation Program Review Out-of-State …
this review, includes only those services provided to individuals enrolled in the fee for service program. The Managed Care contractors manage the out-of-state services provided to the HealthWave population. The Kansas Medicaid out-of-state program functions under the ... Medicaid fee schedule which is the services Medicaid program,
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Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106 ... KS 24-0012 Approval Date 9/10/2024 Effective Date 7/1/2024 Supersedes KS 22-0011 . KANSAS MEDICAID STATE PLAN ... state developed fee schedule rates are the same for both
Table of Contents State/Territory Name: KANSAS
Topeka, KS 66612-1220 RE: TN 24-0019 Dear Medicaid Director Osterlund, The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed Kansas State Plan Amendment (SPA) to Attachment 4.19-B 24-0019, which was submitted to CMS on August 28, ... state developed fee schedule rates are the same for both governmental and private ...
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Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106 ... The agency’s established fee schedule rates are published on the agency’s website at ... the corresponding schedule; d. Click the schedule TXIX. KS 23-0017 Approval Date: 06/16/2023 Effective Date: 04/01/2023 Supersedes: New ...
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Table of Contents - Medicaid.gov
Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 ... Health and Environment Division of Health Care Finance Landon State Office Building 900 SW Jackson, Suite 900 N Topeka, KS 66612-1220 Re: Kansas State Plan Amendment (SPA) 23-0016 ... The state’s rate is as follows and the state’s fee schedule is ...
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KANSAS MEDICAID STATE PLAN KS 20-0022 Approval Date _____ ___Effective Date 01/01/21 Supersedes KS 18-0012 Attachment 3.1-A Page 6 ... Except as otherwise noted in the plan, state developed fee schedule rates are the same for both governmental and private providers these screening services. The agency’s fee schedule rate for maternal
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Table of Contents - Medicaid.gov
Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106 Medicaid and CHIP Operations Group July 26, 2022 ... 900 SW Jackson, Suite 900 N Topeka, KS 66612-1220 Re: Kansas State Plan Amendment (SPA) 22-0013 Dear Ms. Fertig: The Centers for Medicare & Medicaid Services (CMS) reviewed your Medicaid State Plan
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Table of Contents - Medicaid.gov
Interim Medicaid Director Deputy Secretary of Agency Integration and Medicaid KDHE, Division of Health Care Finance Landon State Office Building 900 SW Jackson, Room 900-N Topeka, KS 66612-1220 RE: KS-23-0039 Dear Interim Medicaid Director Osterlund, We have reviewed the proposed Kansas State Plan Amendment (SPA) to Attachment 4.19-B which
Table of Contents - Medicaid.gov
Centers for Medicare & Medicaid Se1vices 601 E. 12th St., Room 355 Kansas City, Missouri 64106 ... Health and Environment Division of Health Care Finance Landon State Office Building 900 SW Jackson, Suite 900 N Topeka, KS 66612-1220 Re: Kansas State Plan Amendment (SP A) 23-0022 Dear Ms. Fe1iig: ... state developed fee schedule rates are the ...
2023 Medicare and Medicaid Fee Schedules Medicare Fee …
Link to fee schedule. NGS Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rho de Island, Vermont . Link to fee schedule WPS Jurisdiction 5 Iowa, Kansas, Missouri, Nebraska . Link to fee schedule. WPS Jurisdiction 8 Indiana, Michigan . Link to fee schedule CGS Jurisdiction 15 Kentucky, Ohio . Link to fee schedule ...
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LAM5M110 LOUISIANA MEDICAID MANAGEMENT …
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2024 Medicaid Physician Fee Schedule - Cabinet for Health …
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Table of Contents State/Territory Name: KS State Plan …
governmental and private providers. The agency's fee schedule rate was set as of 07/01/2018 and is effective for services provided on or after that date. The agency's established fee schedule rates are published on the agency's website at https:// www.kmap-state-ks.us TN# 18-0011 Approval Date 11/23/2018 Effective Date 07/01/2018 Superseded NEW
Table of Contents - Medicaid.gov
__X __ The state is establishing a state specific fee schedule for COVID-19 testing pursuant to sections 1905(a)(4)(F) and 1902(a)(30)(A) of the Act. The state’s rate is as follows and the state’s fee schedule is published in the following location: DR SPA KS-20-0012 authorizes the waiver of cost sharing for testing with the effective
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NEW MEXICO MEDICAID FEE FOR SERVICE CPT CODE FEE SCHEDULE Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained ... 0445T Y $0.00 General Fee Schedule - 7/1/2016 0792T Y $29.00 General Fee Schedule - 7/1/2023 10004 Y $50.11 General Fee Schedule - 7/1/2023 ...