Providers: New Information | Professional Development |Forms & Manuals | Clinical Guidelines | Provider Enrollment | WISEWOMAN | Frequently Asked Questions
Breast and Cervical Reimbursement Rates Updated
BreastCare recently completed an update of the breast and cervical reimbursement rates. Updates including adding several new codes, deleting codes no longer covered and updating the reimbursement amounts to reflect current Medicare rates. The updated reimbursement rate tables along with an updated billing manual and procedures codes to provider types/specialties/diagnosis codes document can be found under Billing Information and Manuals on the Forms and Manuals page. A link to this page is provided at the top of this page.
MRI Now Covered Under Certain Conditions
Magnetic Resonance Imaging (MRI) procedures (77058 and 77059) can now be performed for BreastCare patients under certain conditions. A breast MRI should only be performed in conjunction with a mammogram for women with a higher risk. This includes women with a BRCA mutation, a first –degree relative who is a BRCA carrier or a lifetime risk of 20% or greater as defined by risk assessment models. A breast MRI can also be used to better assess areas of concern on a mammogram or for evaluation of a patient with a past history of breast cancer. A breast MRI should never be done alone as the only breast screening procedure.
Virtual Training Opportunities on BreastCare Billing:
Do you or your staff have questions about BreastCare billing policy, the claim submission process, or Provider Electronic Solutions (PES) software? Are you unable to travel to BreastCare training workshops held throughout the year at various locations? Then a virtual training workshop is for you! Now you can attend a class without leaving your office. The Arkansas Department of Health and HP Enterprise Services invite you to attend useful classes in an Internet virtual classroom environment. The classes are designed to help you:
- configure software for prompt and accurate billing
- understand fundamentals of the claim submission process, issues surrounding claim denials and actions you can take to prevent future denials
- Set-up and use PES to submit claims
- register for and use WebRA
Click here to view and register for upcoming classes. For questions, contact Karen Young at firstname.lastname@example.org.
BreastCare’s Resource Directory
January 3, 2014 - BreastCare has a new resource directory for women who have been diagnosed with breast or cervical cancer. This directory consists of a number of breast and cervical cancer treatment resources to aid women who have been diagnosed with cancer. Resources are organized geographically in sections including National, State, Northwest Arkansas, Northeast Arkansas, Central Arkansas, Southeast Arkansas and Southwest Arkansas. Additional resources are available on Patient Assistant Drug Programs, Clinical Trials, Health Coverage and Transportation.
Click here to download the directory.
BreastCare Makes it Easier to Find Referring Providers
December 9, 2013 - Enrolling/primary care providers who need to refer a BreastCare patient, have a new way to find facilities and doctors who accept referrals for BreastCare patients. A list of referring providers has been added to the BreastCare website under the Forms and Manuals section. The list include surgeons, OB/Gyns, mammography facilities and hospitals.
BreastCare Screening and Diagnostic Services to Continue
Although the Breast and Cervical Cancer Treatment Category 07 Medicaid has ended, BreastCare continues to provide breast and cervical cancer screening and diagnostic services to women just as it has for many years. Despite the changes in the insurance market, Medicaid, and Health Care Reform, some women between the ages of 40 and 64 will remain eligible for BreastCare. BreastCare will continue to provide these needed services at no cost, for eligible women, across the state of Arkansas.
Patients may be eligible for health coverage in the Health Care Independence Program (also known as the Private Option) or through the Health Insurance Marketplace. See details of each below.
Health Care Independence Program
Health Insurance Marketplace
- Household income at or below 138% of Federal Poverty Level
- Adults 19-64 years of age
- Medicaid pays insurance premium and deductibles for covered individuals/family (Small copays may apply for some services depending on income)
- No date restrictions on enrollment
- Call 1-855-372-1084 or go to local DHS office, or
- Go to: www.access.arkansas.gov, or
- Go to: www.insurark.org
- Household income above 138% up to 400% of Federal Poverty Level
- Adults 19-64 years of age
- May be eligible for financial assistance (subsidy/tax credit) toward insurance premium
- Open enrollment ends March 31, 2014 for coverage during 2014.
- Call 1-800-318-2596 for the Federal Call Center, or
- Go to: www.healthcare.gov, or
- Go to: www.arhealthconnector.org
BreastCare cannot transition women to either of those programs. For assistance please call 1-855-283-3483 for In-Person Assistance, or going by a local health unit to see an In-Person Assistant (IPA).
IPAs help individuals/families understand their options so they can choose the best plan for their needs.
BreastCare Materials Available to You
As a provider you may request BreastCare outreach materials, brochure stands, educational materials, and much more. To see what items are available please click here.
If your claim is denied, verify that your claim contains correct NPI number, performing provider taxonomy (if it exists), and appropriate office visit procedure code and that the on-line BreastCare system contains the matching patient ID, date of service, exam type and procedure results (CBE, Pap test, if applicable and/or mammogram) and re-file claim. For questions contact 1-855-661-7830.
2012 US Preventive Services Task Force 2012 Recommendations for Routine Pap Testing
BreastCare is implementing these new recommendations effective immediately. A woman can choose to have a Pap test every 3 years or if she would like to lengthen the time between testing she can choose to have a Pap test and high-risk HPV test every 5 years. Established patients who have had normal results, are not high risk, and have a cervix are transitioned to either the 3 year (36 months) or 5 year (60 months) track based on the date of the last documented Pap test. The laboratory performs the HPV test with each Pap test on the 5 year track. The provider must mark Pap and HPV on the lab requisition. For those on the 3 year track, HPV high-risk reflex tests are performed on all ASC-US Pap results. Once a patient has selected a Pap track she must stay on that track for routine screening. She cannot alternate between tracks. It is no longer necessary to have 3 consecutive, negative Pap tests before reducing the frequency. High risk patients will continue to receive Pap tests every year. “Know Your Choices for Routine Pap Testing” is an informational sheet developed for the patient so that she can make an informed decision about her Pap frequency. You can. This informational sheet is available in English and Spanish. Call Renee House at 501-661-2018 with questions.
Abnormal Vaginal Bleeding
Symptoms of cervical cancer include:
- post-menopausal bleeding
- perimenopausal bleeding
Any perimenopausal vaginal bleeding after amenorrhea for six months or any post-menopausal vaginal bleeding after amenorrhea for one year must be considered a symptom of cervical cancer. This requires a Pap test and a referral for Gyn consultation, regardless of a negative Pap test.
Note: Patients with post-menopausal vaginal bleeding are referred to the Regional Care Coordinators. The duration and amount of bleeding should be documented.
Exception: Patients who have had benign hysterectomies and do not have a cervix are referred to their primary care provider. Any patient who still has a cervix receives appropriate cervical services which are reimbursable.
|No menstrual cycle for 6 months or more and vaginal bleeding occurs>
||Perform a Pap test and refer for Gyn consultation with Pap report
|No menstrual cycle for less than 6 months, and vaginal bleeding occurs,
||Do not refer for Gyn consultation. This is not considered a symptom of cervical cancer.
|Woman is only spotting
||Do not refer for GYN consultation.
Ultrasound Required for Palpable mass
Breast ultrasound and diagnostic mammogram must be ordered per BreastCare policy in the presence of a palpable mass. These procedures should be done on the same day for the convenience of the patients and to decrease delay in diagnosis. If the ultrasound is not performed when ordered, the patient will be rescheduled at the same facility for the procedure. The patient must be referred for a surgical consultation unless the ultrasound reveals a cyst or benign abnormality.
Referrals to Arkansas Tobacco Quitline
The smoking status of all BreastCare clients must be reported to BreastCare on the Screening Form. Current smokers should be referred to 1-800-Quit-NOW (1-800-784-8669 for assistance to quit smoking.
Archived Provider Information