Wiki Missouri Medicaid Healthy Blue

[belindapearl]

Is anyone else having issues with Medicaid Healthy Blue? We started having several of our E&M visits being denied for being in global. I appealed them, the appeal was denied stating they are following MOHealthnet guidelines on global. Well MOHealthnet guidelines is there is a 30 day global on any procedure reimbursing more than $75. So I contacted our Healthy Blue rep and my response was they are following the 30 day global, but they do not have to follow the $75 rule. So basically if you perform any procedure the patient is in a 30 day global. An example a new patient came in for an injection (20600) it only pays I think around $30, so we get paid for the injection, no E&M even though are new, then for the 2 week follow up we can not bill an E&M. They state they are following correct coding policies. I asked what policies but have not gotten a response.

I have never had an insurance to make up their own rules like this. I have emailed MOHealthnet rep, I don't think this is going to help much. We will have to stop taking Healthy Blue, because our office can not afford to see them.

Any suggestions?

 

[OpenClaims]

This seems odd to me, because an injection does not have a global period. What exactly is being billed for the visits after the injection for CPT, just an E/M?

 

[belindapearl]

This seems odd to me, because an injection does not have a global period. What exactly is being billed for the visits after the injection for CPT, just an E/M?

Yes, it was just an E&M visit. They are stating that they are following correct coding guidelines. When I asked what guidelines they are following they did not reply. They also state that they do not have to follow our state Medicaid guidelines

 

[OpenClaims]

I don't think that is correct, and I don't think I'd really want to do this either, but I wonder if you append a modifier 24.

Like I said, I think the whole denial is odd. I work denials/edits daily and have never heard of this.