Wiki Billing insurance

[stacimurillo]

I work as a coder in a small practice. The office has a policy that we do not bill the insurance company without a copy of the insurance card. We have a Medicaid patient that does not have her card, but Medicaid called and said she has coverage. The office manager still refuses to allow me to bill Medicaid. As participating providers, aren't we obligated to bill the insurance company? Are were putting ourselves at risk?

 

[LLynn29]

Yes.
There are several different ways to verify Medicaid coverage through web sites etc. Our office front desk staff always verifies coverage even if the patient presents a card. The flip side is that a copy of an insurance card doesn't necessarly mean the patient has coverage.

 

[nsteinhauser]

What does the manager propose to do - bill the patient? Look up the provider manual for your state's Medicaid - under billing policies. Commercial payors we participate with - and our state's Medicaid - prohibit participating providers from billing actively covered patients for covered services until after they (the payors) have adjudicated/processed the claims. Should patients present with their cards? Yes. Does that card guarantee active coverage? Not at all. Verifying active coverage online and/or over the phone is necessary with or without the card. You don't want a patient to call your state's attorney general and complain that you billed them for services that were otherwise covered by their Medicaid.

 

[stacimurillo]

Yes, the manager is making it self pay. She insists that the patient should have had her card, which I agree, but Medicaid called us and confirmed her coverage, and yet my manager still refuses to let me bill it to Medicaid. I know we have agreed to not bill the patient for covered charges, but she does not seem to understand me when I tell her this. I just wondered what kind of risks we are putting ourselves at. I am a CPC, and don't really want to get into trouble, but I don't know what to do. Thanks for your responses.