New Requirement for Hospital Urine Drug Screening

As a result of the passage of SB 864 earlier this year, beginning 1/1/23, acute care hospital labs that perform urine drug screening must include testing for the presence of fentanyl. The law was in response to the current epidemic of overdoses and has a sunset or end date of 2028 unless the Legislature subsequently extends the sunset date. The relevant provisions of SB 864 are:

 

  • (b) If a person is treated at a general acute care hospital and the hospital conducts a urine drug screening to assist in diagnosing the patient’s condition, the hospital shall include testing for fentanyl in the urine drug screening.
  • (c) As used in this section, “urine drug screening” means a chemical analysis intended to test patients for the presence of multiple drugs, including cocaine, opioids, and phencyclidine.
  • (d) This section shall remain in effect only until January 1, 2028, and as of that date is repealed.

Important Changes to Medi-Cal FFS Documents

As announced on July 14, 2022, at the direction of the State Controller’s Office (SCO), the Department of Health Care Services (DHCS) is preparing to discontinue the printing and mailing of Medi-Cal Remittance Advice Details (RAD), Electronic Funds Transfer (EFT) and No Pay documents. The SCO will continue printing these documents until the paper supply is exhausted. DHCS will end-date mailings at that time. Note: The Medi-Cal checkwrite schedule will remain unchanged, and provider warrant release dates and EFT dates of deposits will continue without interruption.


Given the imminent discontinuance of these paper documents, providers must take action quickly to not only gain access to Medi-Cal web services, but also incorporate the electronic versions of these documents into their daily operations. At minimum, providers will need to transition from the paper documents noted above to PDF RADs. The HIPAA X12N version 5010 835 Claim Payment/Remittance Advice (HIPAA 835) is also available. Both PDF RADs and the HIPAA 835 require providers to log in to the Medi-Cal Transaction Services secured site section, using their National Provider Identifier (NPI) and Provider Identification Number (PIN), to access these files. Providers must have a signed Med-Cal Point of Service (POS) Network/Internet Agreement form on file to log in to Transaction Services. This agreement grants immediate access to PDF RAD files. The HIPAA 835, however, also requires completion of the Electronic Health Care Claim Payment/Advice Receiver Agreement before these files are made available.


In addition to the articles that have been posted to the Medi-Cal website regarding this impending change, all providers who do not have a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file, were mailed a notification letter providing instruction on what steps were required:

  • Impacted providers are required to complete the Medi-Cal Point of Service (POS) Network/Internet Agreement form to gain access to their PDF RADs before the paper document distribution is end-dated.


The Medi-Cal Point of Service (POS) Network/Internet Agreement form is now available electronically. This is the preferred submission pathway, as it allows the agreement to be processed more quickly and saves on envelope and postage costs. Alternatively, the paper form is published to the Medi-Cal Providers website and can be downloaded and submitted as instructed on the form for processing. This is a positive and beneficial change for the provider community: Providers can use their secure Medi-Cal login to view and download your PDF RADs from anywhere, at any time. PDF RADs are free; there is no charge for the online service. They contain the same information as their paper counterparts, and they are adequate to submit as supporting documentation with Claims Inquiry Forms (CIFs) and Appeal Forms.


For additional information about PDF RADs, form completion or resetting a provider PIN, providers may contact the California MMIS Fiscal Intermediary Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Providers website (www.medi-cal.ca.gov).

Registration is OPEN for the CSP 75th Annual Meeting:

Seminars in Pathology

Nov. 29 - Dec. 3, 2022


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