Medi-Cal Discontinues Payment on Certain Clinical Codes
As part of Medi-Cal’s General Medicine update released in May, California’s State Medicaid program announced plans to discontinue split billing (PC, TC and ZS) for 88 select laboratory codes. The Bulletin (469) stated that this change was due to be effective July 1, 2014. The California Society of Pathologists (CSP) has reached out to the DHCS opposing the change, citing that it is inconsistent with the new DRG payment system Medi-Cal uses to reimburse hospitals; which specifically excludes the professional component of anatomic and clinical pathology from the DRG payment. CSP has since reported a delay in this policy, but no new implementation date has been released by Medi-Cal. APS will continue to monitor this situation and report to you as soon as we have more complete information.
"APS performed a comprehensive Coding Audit Review and subsequent financial impact assessment resulting in a significant increase in our revenue."