medicaid billing

  1. L

    Pain management-- Drug testing

    Hi Everyone! I am hoping to get some help with in house lab billing for TOX SCREENING/CONFIRMATION. My provider is a pain management provider who bills 80307 and G0481 for Maryland Medicaid patients. I am getting denials from the MCO'S to bill Optum MD and Optum MD is denying the provider type...
  2. E

    Question CMS/Medicaid Pay To Provider Question

    Hello, We have been having problems with our billing system where MEDICAID claims are paying to the member's PCP, not the rendering provider. Before going to the manufacturer to get changes to our billing system, is this a Medicaid or CMS rule/regulation? I have searched their website through...
  3. H

    Annual Exam

    I work for an outpatient OB/GYN Center. Most of our patients are Medicaid patients. If a patient had a preventive visit last year but pap was not due, can I code a preventative visit this year if the PAP was done? My providers are telling me Medicaid will only allow a preventive visit every 2...
  4. M

    Billing E/M code for preventive exam

    Since Medicaid (Alaska) will not cover preventive exams for patients over 20 years old, is it appropriate to bill an E/M code for these visits? Thanks!
  5. B

    Hospice Inpatient - Provider Not employeed with Hospice

    My provider is a family practice doctor who recently had a Hospice patient as Inpatient. The patient was seen for Hospice related diagnosis and has Medicare as primary and Medicaid secondary.... Can I bill medicaid? I am aware of modifiers GV and GW... We are based in Louisiana. I am having...
  6. E

    If PT has only Medicare Part A and Medicaid as 2nd...

    Hello. If patient has Medicare Part A only and Medicaid as 2nd - will Medicaid cover if the patient doesn't have Part B? ie, can my provider still bill for the inpt services to Medicare, get the denial and we can bill Medicaid?
  7. A

    Billing for services before MH assessment?

    I work for a Medicaid organization and am wondering if it is appropriate to bill for services before an assessment is done. For example... 1. Case Manager works on paperwork for a member for 30 minutes for housing prior to taking them face to face to Housing Authority for 1 hour- Can they bill...
  8. A

    Medicaid Child & Adolescent Medication Management

    I cant find this in the Medicaid Manual or anywhere. My child psych doctors were told that whenever they do med mgt in day treatment program, they have to bill low whenever the parent is not around. I'm so confused on it. Does anyone have any input?
  9. M

    NC Medicaid-85018

    My doctor wants cpt 85018 billed when performed for patients during pregnancy. These are denying for Missing/incomplete/invalid CLIA certification number. Not sure why because the CLIA is on the claim box 19. Any advice on getting these paid?? Any advice is appreciated! Thanks so much :)
  10. A

    Multiple providers for antepartum care

    I work for a small clinic in Northern California where our primary payor is Partnership (MediCal/Medicaid based). Our independent contractors and locum tenens are rotated in our clinic for a few weeks at a time. Our patients may see up to 5 different providers during their pregnancy. As I am...
  11. K

    Billing Medicaid for School Nurse Services

    Hello, I'm trying to reach out to learn if I have a colleague who also works with coding and billing (Medicaid) for school nursing services and IEP billing for nursing services. I work in the state of South Carolina for a school district with 83 schools over 800 square miles, ~70,000...