Wiki Global Pregnancy coding when Medicaid 2ndary

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dlbroyles26

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I am looking for anyone's advise out there in regards to patient's that have a commerical primary insurance and Medicaid as secondary and they are being seen in your office for their pregnancy. How do you handle the fact that all commerical insurance companies want you to bill all office visits in with the delivery as a global and Medicaid has there own set of stupid rules and everything is at time of service and delivery only. So once the baby delivers you have been paid by primary and they put the majority to the patient's deductible and Medicaid is not going to touch it because it is not a recognized code by them. What does your practice do just eat it and write it off. We have gotten so many different answers from Medicaid representatives it is ridiculous. Please advise us on any solutions you might have. Thank you in advance for your assistance.

Debbi B
 
Global delivery

Once your commercial carrier pays, change your CPT to Mcd guidelines and send with commercial EOB. You should not miss a deadline since the date on the EOB is what they will go by rather than the date of service for the visits.
 
Ronna, am I understanding you correctly that you go back and change all of the global office visits to 99213 and bill those to Medicaid with the EOB from the delivery?

Debbi B., CPC
 
Mcd secondary billing

Yes, that is how Medicaid had us handle our OBs when a commercial insurance was primary. We would send the amended claims with the primary EOB.
 
Any Solution???

Hi Debbi,

I know this was from a while back but I am curious as to how the solution provided to you above has worked out for you? I have run into the same issue and I am dealing with the same run around from representatives. Where I work, the solution above would affect a few reports so I am really trying to find a solution that doesn't involve amending so many claims. Any help is much appreciated!!!

Thanks,

Sam :)
 
I also would like to know if anyone else is still having this issue. Our clinic is constantly having patients with commercial plans and Medicaid secondary. I have never heard of unbundling the codes after the primary eob comes back. Has this been working for you? And also what state are you in? We are in Washington.
 
Global delivery/medicaid secondary

In Texas if the primary insurance pays more than what Medicaid would have allowed for the procedure, the balance must be written off. I have not heard of unbundling a global code. I would think you would have to know from the primary carrier how much they paid for each antepartum visit and then if it is less than Medicaid you could bill them and I would think you would have to have that in writing as an eob. The clinic I worked for did not accept Medicaid as a secondary payor for this reason.
 
Bready:

In SC, a few years ago, Medicaid allowed practices to send in a "worksheet" along with the OB flowsheet reflecting the number of visits and the primary EOB. The worksheet was simply the Medicaid allowable for each office visit X the number of visits the patient had + the allowable for delivery only (this was to unbundle global), then that number was subtracted from the global payment. Medicaid secondary would pay that balance or obviously if the commercial payment was greater, the balance would be denied and adjusted.

Unfortunately, I don't have any recent experience with that method.
 
Global delivery/medicaid secondary

AHGUZMAN,
Thank you for the information on SC. I know that every state has its own guidelines so it was enlightening to learn that another state's medicaid plan actually paid as a secondary to commercial insurance.
 
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