January 2012

Division of Medical Services Newsletter Listserv

The Division of Medical Services will be distributing notification of new issues of the newsletter via a listserv notification. If you wish to be notified each time a new issue of the newsletter becomes available, please sign up for the Medical Services Newsletter Listserv here.

6 Day Inpatient Review

The Division of Medical Services is now tracking all in state acute inpatient hospitalizations starting at day six of the hospitalization. Hospitals are required to submit a notification form on day six of inpatient  stays as well as a notification of the discharge of any SD Medicaid recipient who has stayed 6 days or longer. These forms are available on our web site at and can be submitted electronically or faxed.

Nurse consultants will be monitoring these admissions. This will allow the Division of Medical Services to follow up on long projected lengths of stay and situations that are not consistent with average length of stay. Nurses will use this information to increase efficiencies and identify barriers to discharge.

Payment Error Rate Measurement

The Centers for Medicare and Medicaid Services (CMS) is hosting several Payment Error Rate Measurement (PERM) provider education webinar/listening sessions. The purpose of the sessions is to provide South Dakota Medicaid providers with information regarding their responsibilities for sending requested medical record documentation to the PERM contractors to ensure payment recoveries are not made due to a lack of adequate supporting medical records for the review. Details and materials can be found at Go to the Provider page and access the Cycle 3 Provider Education Webinar link.

Medicaid Solutions Work Group Completes Work

The Medicaid Solutions Work Group was initiated by Governor Daugaard in February, 2011 with the goal of identifying both short term and long term strategies to contain and control future Medicaid expenditures. the group met eight times and had over two dozen members including legislators, providers, state agency staff and was led by Deb Bowman, senior advisor to the Governor. Sub-committees with focus areas of patient centered physician and hospital care, pharmacy services, and home and community based services were formed, and included participation from work group members and additional stakeholders. The group made eleven recommendations in areas such as developing health homes, looking for new ways to manage health care for high cost individuals, reducing emergency room use, increasing co-pays for drugs, putting a limit on adult dental benefits, and exploring the feasibility of several new federal options for home and community  based care and pharmacy services.

Find a link to the recommendations of the Medicaid Solutions Work Group at:


Employee Spotlight - Revi Warne

New to our provider newsletter is the employee spotlight section. First up is Revi Warne.

Revi is a program manager for Medical Services and has worked for the Division for just over three years. Prior to coming to Medical Services he worked at the Divisions of Mental Health, Emergency Management and Economic Assistance. Primary responsibilities with Medical Services include assisting the Director and Deputy Directors with day-to-day operations in Medicaid.

Revi was born and raised in the Pierre area. He graduated from Sully Buttes High School in Onida and South Dakota State University in Brookings with a Bachelor of Science Degree. He served six years in the South Dakota Army National Guard. He makes his home in Pierre with his wife Kea and two children Karlie (17), and Ryan (11).

In his spare time, Revi enjoys time together with family and friends, reading, and suffering through Minnesota Vikings games.

Face-to-Face Tobacco Cessation Counseling

The Centers for Medicare and Medicaid Services (CMS) approved South Dakota's Medicaid State Plan Amendment (SPA) pertaining to coverage of face-to-face tobacco cessation counseling for pregnant women. A requirement of the Patient Protection and Affordable Care Act of 2010 (ACA), the SPA has an effective date of July 1, 2011, and the department projects a nominal fiscal effect.

ACA mandated that states provide for pregnant women coverage of face-to-face tobacco cessation counseling services, and that states amend their State Medicaid Plans accordingly. CMS' implementation of the statute stressed use of the 2008 guidelines by the Public Health Service calling for a minimum of four 15-minute face-to-face sessions per quit attempt and at least 2 quit attempts in a year per pregnant woman. States have the option of allowing the service be provided by or under the supervision of a physician, or by any other health care professional legally authorized to furnish the service. South Dakota chose both options.

South Dakota already had well established the telephonic tobacco cessation counseling program operated by the SD Department of Health known as SDQuitLine located at That service offers free tobacco cessation counseling services provided by trained personnel, as well as medications to all South Dakota residents wanting to quit smoking.

Providers of the face-to-face tobacco cessation counseling must bill the appropriate code for the service and use a diagnosis code for pregnancy.

South Dakota Electronic Health Record (EHR) Incentive Payment Program

Established by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the Medicaid EHR Incentive Payment Program will provide incentive payments for eligible providers for adopting and meaningfully using certified Electronic Health Records (EHRs).

December 5, 2011 the South Dakota Medicaid EHR Incentive Payment Program entered the first phase in launching the program. Phase one will allow eligible hospitals including acute care and children's hospitals to register and attest for the South Dakota program. Throughout December Division of Medical Services will be working with a pilot group of eligible hospitals on the registration and attestation process.

Eligible hospitals must register and attest before December 31, 2011 in order to receive a payment for 2011. Eligible professionals will have until March 30, 2012 to register and attest to receive their 2011 incentive payment. Eligible professionals that include physicians, certified nurse midwives, dentists, nurse practitioners, and some physician assistants are slated for phase two because they have a longer time period to attest for 2011.

If you wish to be a pilot for the SD Medicaid EHR Incentive Payment Program or if you have any other questions, please  contact  Penny Kelley or Selam Fekade at 605-773-3495 or via email at

Sign up for the program listserv and learn more about the program by visiting the program's website at

HIPAA 5010 & NCPDP D.0 Standards

South Dakota Department of Social Services implemented the federally mandated HIPAA 5010 and NCPDP D.0 standards on January 1, 2012 for electronic billing formats. 5010 is the latest version of proposed electronic HIPAA transaction standards, while D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions.

Providers that are currently submitting electronic claims (837I & P) or receiving electronic remittance advices (835) will be affected. South Dakota began conducting validation testing with its Trading Partners for HIPAA 5010, 837I and 837P transactions on November 3, 2011. If you submit electronic claims directly or through Launchpad, you should begin testing immediately. Providers that use billing agents or clearinghouses are encouraged to contact their billing agent/clearinghouse to insure that they have successfully tested with SD Medical Services.

Pharmacies that have updated their software to meet NCPDP D.0 compliance and wish to test should contact their switch to begin testing or to insure that the switch has successfully tested with Medical Services.

South Dakota Division of Medical Services has established a link on its website to provide information on 5010. The link can be accessed here.

This link provides information testing, DSS HIPAA Companion Guide: 5010 Version, 837I, 837P and 835 Transactions Sets, and D.0 payer sheets. Please take time to review these documents prior to testing and implementation.

To receive more information on 5010 and D.0 implementation, please sign up for the EDI Transactions Listserv here.

Provider Enrollment Updates

New Federal Medicaid provider enrollment regulations were enacted as part of the Accountable Care Act. These requirements are already in place for Medicare providers and are geared toward reducing the risk of fraud. The Division of Medical Services (DMS) is currently evaluating the impact for existing and new SD Medicaid Providers.

Four main changes are being required. First, providers are categorized into risk levels which determine the level of screening required to enroll as a provider. The three levels of risk assigned by CMS are limited, moderate, and high. Most of our providers are classified as limited risk and therefore the screening changes include additional checks against additional federal databases. However, more is required for those providers deemed moderate or high risk according to CMS' categorizations.

Secondly, every provider must be re-screened at least every five years using the same requirements and categorizations noted above for new providers.

Thirdly, additional providers need to be enrolled and screened, including several types of providers that do not bill Medicaid and haven't had to enroll in the past including ordering, referring, and prescribing providers and servicing providers at rural health clinics, IHS clinics, and federally qualified health centers.

Finally, providers categorized as 'institutional' must pay a $505 fee to enroll or upon re-screening for Medicare or any State Medicaid program. This requirement will not impact individual providers and clinics, but does apply to hospitals, lab, nursing facilities, etc. South Dakota will work with Medicare and other State Medicaid agencies to avoid duplication of these fees and of re-screening requirements.

With additional guidance released on December 23, 2011, DMS is currently researching allowable exemptions for some types of providers. More information will be forthcoming from DSS once the impact of these regulations has been fully evaluated and an implementation plan has been created. For more detailed information, please refer to the full Federal guidance at  Please, also, review our website periodically for updates at


Comments or questions?
Contact Medical Services

South Dakota Department of Social Services

Division of Medical Services
700 Governors Drive
Pierre, SD 57501
Phone 605.773.3495

Fax 605.773.5246

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