The California Department of Health Care Services (DHCS) began receiving claims on July 1 for the newly established Code 19 rate. Similar to the Code 18 rate for Medi-Cal Managed Care services, Code 19 will be imbedded into the prospective payment system (PPS) rate for services provided by FQHCs and RHCs to beneficiaries of the Children’s Health Insurance Program(CHIP). The Code 19 rate equals the difference between what the clinic receives for Healthy Families services and their Medi-Cal PPS rate.
DHCS is requiring that clinics submit a request form to the Audits & Investigations department to establish an initial Code 19 rate. If you have not yet submitted the request form for payment, your rate will be automatically set at $1. Any amount due to your clinic above this payment will not be refunded to your clinic until after you submit your year-end PPS reconciliation forms, causing a delay in reimbursement.
Now, Palmetto is requiring providers to reduce their bad debts by the actual SOC. If any SOC was actually collected on a claim, then the corresponding Medicare bad debt would be reduced by that amount. If any amount of SOC was uncollectible, then to claim the bad debt for that portion, the provider would have to prove that they made reasonable collection efforts, a difficult process in many cases, and doubly so when trying to collect from Medi-Cal beneficiaries. 
The Patient Protection and Affordable Care Act (ACA) is an ambitious endeavor to improve health care in the United States. One of the ACA’s key features is the Accountable Care Organization (ACO). ACOs will contract with the Centers for Medicare and Medicaid Services (CMS) to provide comprehensive coordinated services for a defined population of Medicare beneficiaries. If they meet quality standards and reduce costs, ACOs will share in the savings.