Wiki Commercial and Medicaid Maternity Billing

[Sarita85]

Hello,

We often have patients that have commercial insurance with Medicaid primary for all of their maternity care. If the patient meets the requirements for a global delivery we will bill the global delivery but in this case the patient doesn't have maternity coverage with her commercial insurance policy. Knowing that Medicaid doesn't cover the global delivery CPT codes and the patient doesn't have maternity coverage, do we split the charges for the patients prenatal, delivery and postpartum care to her commercial insurance so once denied we can bill it to Medicaid? Or do we have to write off the charges?

Thanks for your feedback.

Sarita

 

[karitoon]

In this scenario, our office bills as if the patient has Medicaid only (individual visits, delivery only and pp care split billed). We still file to the primary and then file to Medicaid 2ndary with the denial due to no maternity coverage.

 

[Sarita85]

In this scenario, our office bills as if the patient has Medicaid only (individual visits, delivery only and pp care split billed). We still file to the primary and then file to Medicaid 2ndary with the denial due to no maternity coverage.

Thank you for responding. When you split bill the charges to the primary commercial payer, do you add the TH modifier onto the office visits or do you wait for the denial from the primary and then add the TH modifier to the office visit to bill out to Medicaid?