In Kentucky, Oral Surgeons are enrolled as Dentist along with adding the specialty of the Oral Surgeon. However, there are certain oral surgery codes that are reimbursed under a Physician number and that’s when they will require to enroll as PT 64 Physician as well.

Additionally, some of them are dually licensed as a Dentist and a Physician…

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For Kentucky:

1. We have regularly scheduled meetings with our OIG and MFCU where we discuss the referrals and allow everyone the opportunity to ask questions or for additional information. The referrals are provided for review, and following the meeting official referrals are issued. During the meetings, MFCU usually addresses if they would…

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This has been a source of a lot of frustration in Kentucky. We have been speaking with several areas in CMS to get a response to clarify the expectations on this. It does appear from our most recent correspondence from CMS that if Medicare covers a service not in your state plan for a provider who is providing services to a dual eligible…

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Kentucky does not enroll assistants.

Kentucky does not do prepayment review on the FFS side. Our MCOs may utilize prepayment, but they do have to have a policy submitted and approved by our Department first. It is not required for them to utilize prepayment. Also, they do have to check with us before putting prepayment in place in the event of any open investigations.

Kentucky’s PI portion and penalties are included in this document.

Kentucky does rely on Medicare site visit determination if we are able to do so in PECOS. If not, then we would request for a Site Visit through OIG.

I removed a few from the list that did not apply for us.

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Kentucky has not posted them historically, but we are working toward updating our website with plans to start posting those types of materials. Right now, someone would have to submit an Open Records Request in order to obtain the information.

In Kentucky, our UPIC conducted some DRG hospital audits that proved to be lucrative for us.

I think Kentucky emailed ours. If you didn’t get it, please let me know!

We do not individually enroll in Kentucky. Caregivers are employed through agencies and submit their timesheets individually through EVV. They are not tied to claims or our enrollment system. All monitoring has to be conducted on the back-end.

In Kentucky, we do maintain a list of providers who we will not enroll in our SMA. As for PCAs specifically, we do not enroll those. Those fall under our waiver programs and there are strict guidelines regarding background checks that those individuals go through with the agency that actually employees them through self-direction. We hold…

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