AGENCY COULD LOSE MILLIONS; VENTURA COUNTY FAILED TO SUBMIT MEDI-CAL CLAIMS.Byline: Krystn Shrieve Staff Writer The Behavioral Health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or Department could lose $16 million in Medi-Cal reimbursements because it purposely pur·pose·ly adv. With specific purpose. purposely Adverb on purpose USAGE: See at purposeful. Adv. 1. stopped submitting claims once a federal investigation of its billing practices was under way. State officials say the county department stopped billing for Medi-Cal payments in November 1998 and may only be eligible to receive reimbursements for services provided since March of this year. ``The county has six months from the date of service to submit a claim,'' said state Department of Mental Health spokeswoman Nora Romero. ``There are some triggers, however, that may allow the county to get that money . . . but it has to go through an approval process.'' County Counsel Frank Sieh said officials in the county's Health Care Agency and Chief Administrative Office decided to hold off on submitting Medi-Cal claims to the state because the federal government began questioning the county's Medicare Medicare, national health insurance program in the United States for persons aged 65 and over and the disabled. It was established in 1965 with passage of the Social Security Amendments and is now run by the Centers for Medicare and Medicaid Services. billing. A letter to the county from the U.S. Health Care Financing Administration Health Care Financing Administration, n.pr department in the U.S. agency of Health and Human Services responsible for the oversight of the Medicaid and Medicare benefit programs, including guidelines, payment, and coverage policies. , which investigated the Medicare billing, ordered the Behavioral Health Department to hold off on billing Medicare and Medicaid Medicare and Medicaid U.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. for services rendered between April 1998 and December 1998, during the period of the merger between the Behavioral Health Department and Health Care Agency. In California California (kăl'ĭfôr`nyə), most populous state in the United States, located in the Far West; bordered by Oregon (N), Nevada and, across the Colorado River, Arizona (E), Mexico (S), and the Pacific Ocean (W). , the equivalent of Medicaid is Medi-Cal. ``Our review of the latest materials again demonstrates that your new organization structure is not acceptable for Medicare/Medicaid purposes,'' reads the letter written on Dec. 21, 1998. ``Ventura County should not bill Medicare and Medicaid for services provided by the (Behavioral Health Department) under the reorganization that was put in place in April.'' Romero said, however, that the county could have resumed Medi-Cal billing in March of this year. ``The county called our department in early May and asked if they could resume billing and we said of course they could, and followed that up with a letter later in May,'' Romero said. ``It wasn't until August that they called and asked for technical assistance. We dropped everything and sent a team down there.'' A team of state officials looked over the county's Medi-Cal billing last week. A report on its findings are expected to be released by the state on Friday. County officials were confident their billing procedures were in order, and the funds would be reimbursed. ``The team told us verbally that our billing is fine,'' Sieh said. Romero explained that Medi-Cal billing by all counties is filed electronically - usually on a monthly basis. Claims go first to the state Department of Health Services Department of Health Services may refer to:
The exceptions for recouping money beyond the six-month period are called ``good-cause reasons'' - such as failure of a patient to present a Medi-Cal card or natural disasters, theft, court decisions or circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact. 2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or related to the Medi-Cal certification or recertification recertification Recredentialing Graduate education A process in which a professional is periodically re-evaluated–eg, every 10 yrs by an accrediting body to assure continued provision of safe, high-quality health care of the provider. State and federal audits and investigations that have been pelting the department since last year's failed merger, have turned up various department blunders which have already cost millions and could cost millions more. The Board of Supervisors is awaiting final approval from the U.S. Attorney's Office on an offer to pay back $15.3 million in Medicare reimbursements over a five-year period. In addition, the state also said this month that it is withholding Withholding Any tax that is taken directly out of an individual's wages or other income before he or she receives the funds. Notes: In other words, these funds are "withheld" from your wages. $5.3 million from the Behavioral Health Department's Systems of Care programs until the department shows it is making more of an effort to include members of the community in program improvements. The county is expected to reorganize re·or·gan·ize v. re·or·gan·ized, re·or·gan·iz·ing, re·or·gan·iz·es v.tr. To organize again or anew. v.intr. To undergo or effect changes in organization. its budget in October to reflect the Behavioral Health Department's lack of funding. |
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