Practice Management Alert

4 tactics help you handle your state program's unique billing requirements

State-run medical assistance programs present a unique billing challenge, but you can cure the headache by revamping the way you handle these claims.

Each state has its own program to offer financial assistance on medical costs to its population's poorest members, says Merrie Gaik, CPC, office coordinator at Charlotte Surgery Center in Port Charlotte, Fla. In Florida, "we have a program called Medically Needy" (MN) run by the state's Department of Children and Families, she says.

Another example: Pennsylvania offers a program called Medical Assistance (MA) through the Department of Public Welfare, says Pat Suhr, RN, CPC, billing manager at Maternal Fetal Medicine of Central PA in Harrisburg.

Each of these state-run programs has its own claims filing process, but you can adopt the following four tactics to improve claims success regardless of your state's requirements.

1. Keep a list of accepted codes for your most common procedures. Many state-run programs have different CPT requirements and accept different modifiers and ICD-9 codes than Medicare and other carriers. You should also pay attention to how your program lists each procedure's place of service, Suhr says. Update this list every time you learn something new so that next time you can submit your claim correctly and get paid without an appeal, she adds.

2. Know the details of your program pertaining to timely filing limits and preauthorization. For instance, MA gives you 180 days to file a claim, Suhr says. Because you must rely on the patient to complete certain paperwork before he is eligible and you can file the claim, being aware of the filing deadline is very important, she adds.

In Florida, MN requires preauthorization for a handful of procedures - and will deny payment if you didn't fill out the necessary forms first, Gaik says. If your state has preauthorization requirements, keep a list of procedures that need a pre-auth to make sure you don't sacrifice payment.

3. Store all EOBs and claim correspondence in one binder for easy reference. Having all your state-run assistance program EOBs in one place will allow you to "go back through and learn from them all the time," Suhr says. And keeping copies of appeal letters, attachments, claim forms and details from phone discussions with the program's claims processor will ensure each claim's entire history is easily accessible if you need to follow up for payment, she says.

4. Initiate better communication between the billers posting payments and the billers posting charges, Suhr says. If the billers posting payments are finding mistakes on the back end, they can help prevent future rejections by alerting the billers who file the claims, she says.