Posts Tagged maternity

Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

 AL.com – Anna Claire Vollers

In the wake of increased attention to a rising maternal death rate, a growing chorus is calling on Alabama to investigate the deaths of mothers from pregnancy and childbirth complications.

“Each and every maternal death is devastating to families, and leaves everyone asking ‘why?’” said Dr. John Meigs, president of the Medical Association of the State of Alabama, in a statement. “As physicians, we feel like our state has got to do better, can do better and must do better, and our coalition partners feel the same way.”

In recent weeks, the Alabama Department of Public Health asked Gov. Kay Ivey for $478,000 to better investigate why Alabama mothers are dying from pregnancy and childbirth complications.

If the request makes it into the governor’s state budget recommendation, then the Medical Association, the nonprofit March of Dimes and consumer giant Johnson & Johnson are gearing up to push for the funding in the upcoming legislative session.

In states like Texas and Tennessee, efforts to investigate maternal deaths have found most of the deaths could have been prevented. Investigations in states like California and North Carolina led to changes in healthcare and services provided to mothers.

Alabama doesn’t really know why mothers are dying from childbirth and pregnancy complications. Or even how many.

“But until we have a thorough review of the maternal death data, we can’t answer the all-important question of ‘why?’ and take steps to stop maternal deaths,” said Meigs.

Officially, 41 mothers died from pregnancy or childbirth complications in 2017, according to death certificate data reported by the state. It’s the highest number of deaths related to childbirth and pregnancy that Alabama has recorded in recent years.

But using just the death certificate data has been shown to be unreliable. The U.S. Centers for Disease Control and Prevention doesn’t recommend using those numbers alone to get an accurate count of maternal deaths.

Instead, the gold standard for investigating deaths of mothers from pregnancy and childbirth is a statewide task force called a Maternal Mortality Review Committee, which reviews medical records and other documents related to every death of a mother, related to childbirth or pregnancy.

All of Alabama’s neighboring states have one already.

If the $478,000 is approved by the state legislature next year, it would fund Alabama’s new MMRC. Late last year, a coalition of Alabama doctors, nurses, public health leaders and other formed the state’s first MMRC under the umbrella of the Alabama Department of Public Health.

Right now, the MMRC operates on a shoestring budget, limiting the number of cases it can review. It’s mostly staffed with volunteers.

A group of Alabama OBYNs and the Medical Association worked with ADPH to come up with the $478,000 figure, said Trace Zarr, director of political development at the Medical Association.

The bulk of the money, about $300,000, would go toward hiring paid staff to compile and organize the case files of Alabama women who died from pregnancy or childbirth-related issues.

Another $108,000 would go toward autopsy reviews, and the rest would pay for support staff, equipment and supplies.

“We want to make sure we get not only a good count of the number of deaths, but qualitative data on the broader factors associated with these deaths,” said Britta Cedergren, director of maternal-child health and government affairs with the March of Dimes, which has partnered with the medical association and the state health department to lobby for funding.

“We want to determine whether these deaths were preventable. If it was a postpartum depression-related suicide, what could have been done differently? Or was there an undiagnosed issue related to pregnancy, like hypertension?”

If the MMRC is fully-funded, it could have a lasting impact on the health of mothers in the state.

Tennessee, which launched its MMRC program two years ago, found a whopping 85 percent of its maternal deaths were preventable.

California, one of the first to launch a review committee back in 2006, has since cut its rate of women dying in childbirth by 55 percent. That’s due in large part to is committee identifying two complications that were killing mothers but were largely preventable: hemorrhage and pregnancy-induced high blood pressure.

And Alabama already has a similar program that investigates infant deaths. Meigs credits the state-funded infant mortality review for reducing Alabama’s infant mortality rate in recent years. In 2017 Alabama’s infant mortality rate, still high by national standards, hit a state-record low.

“But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so and dig down into the root causes of maternal death in this state,” he said, “we can’t expect to be able to make informed health policy decisions as a state, to move forward in eradicating maternal deaths.”

The Medical Association, a private professional organization that lobbies state lawmakers on behalf of doctors, has recently launched a new initiative, the Save Alabama Moms campaign. On its website, alabamamedicine.org/savealmoms, is the tagline: “It’s time to solve the maternal mortality crisis.”

Read more on motherhood in Alabama at al.com/motherhood. Join the conversation around issues that matter to women in the South on the Reckon Women group on Facebook. And for the best stories delivered straight to your inbox, sign up for our Reckon Women newsletter.

Click the image above to learn more about Alabama’s maternal mortality crisis.

Click the image to view the document outlining our request to fund the MMRC.

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Posted in: Advocacy

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New Requirements for Fee-For-Service Delivery Claims

New Requirements for Fee-For-Service Delivery Claims

Effective for dates of services on or after Feb. 1, 2018, fee-for-service delivery claims for recipients who reside in a county not served by an Alabama Medicaid (Medicaid) Maternity Care Program must contain the date of last menstrual period and the date of first prenatal visit. This information is not required for hospital claims.

Counties not included in a Medicaid Maternity Care Program:

District 10:  Autauga, Bullock, Butler, Crenshaw, Elmore, Lowndes, Montgomery and Pike
District 12: Baldwin, Clarke, Conecuh, Covington, Escambia, Monroe and Washington

Soft Denial:
Claims without the date of last menstrual period and the date of the first prenatal visit will receive a “soft” denial.  This means the claim will process, but the provider will receive an alert to remind them to include the information.

Hard Denial:
On Feb. 1, 2019, claims that do not include the date of last menstrual period and the date of the first prenatal visit will be denied.

Some examples of what a provider can expect to see on the denied claim include:
Edit 330 – DTP SEGMENT DATE IS INVALID
Edit 331 – DATE LAST MENSTRUAL PERIOD MISSING OR IN FUTURE

Edit 332 – DATE FIRST PRENATAL VISIT MISSING OR IN FUTURE

Claims with the procedure codes below must include the date of last menstrual period and date of the first prenatal visit:

  • 59400-59410     Vaginal delivery
  • 59510-59515      Cesarean delivery
  • 59610-59622     Delivery after previous cesarean delivery

How can a fee for service provider submit a claim?

  • For claims submitted through 5010 X12 837P:
    1. Enter the date of the patient’s last menstrual period in a DTP segment in loop 2300 with a qualifier of 484
    2. Enter the date of the patient’s first prenatal visit in a DTP segment in loop 2300 with a qualifier of 454
  • For claims submitted on the Medicaid Interactive Web Portal:
    1. Enter the date of the patient’s last menstrual period in the field labeled “last menstrual period date”
    2. Enter the date of the patient’s first prenatal visit in the field labeled “first prenatal visit date”
  • For paper claims submitted on a CMS form 1500:
    1. Enter the patients last menstrual period in block 14
    2. Enter QUAL the value “484” to identify the information in block 14 as the date of the last menstrual period.
    3. Enter QUAL the value “454,” which identifies the information entered as the date of the first prenatal visit in block 15
    4. Enter the date of the patient’s first prenatal visit in block 15
    5. If no prenatal care was received, the date entered in block should be the date of the first contact during the pregnancy.

*Reminder:  Medicaid requires all claims be filed electronically unless they are required to be submitted on paper.

  • PES does not currently allow claims to be submitted with this information, but a software upgrade will be available prior to claims denying for not containing the information.

Note:
Providers within the Maternity Care Program must continue to follow guidelines outlined in the April 13, 2017 ALERT. Please visit http://medicaid.alabama.gov/alert_detail.aspx?ID=12209 for a copy of the ALERT.

Please direct questions to the Fiscal Agent, Provider Assistance Center at (800) 688-7989.

Posted in: Medicaid

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