Wiki NC Medicaid and PostPartum complications

[LanaW]

Please help - this is what happened....

Patient delivered in a city other than ours - delivered by an entirely different OBGYN practice.

Patient presented to our ER with a PP infection and was admitted by one of our MDs. We followed this patient for a few days in the hospital and then discharged her.

We billed for this and it was denied due to being part of the global pkg. I sent in the appropriate forms for reconsideration with notes from the hospital visit. NC Medicaid still denied it due to "part of the global". I called them today to get some info on getting this paid and was basically told - "too bad".

Any suggestions?

Thank you!
Lana

 

[m.j.kummer]

Call the State Representative for your district. Explain to them that this type of situation is exactly why a national health care plan will not work. Ask them to intervene for your doctor. Then call your Medicaid representative back and ask to speak to the supervisor, keep going up the ladder until you get a valid answer. Contact the provider that billed for and obviously got paid the global fee and ask for payment. Be a squeaky wheel. It is the only way you will get the reimbursement that the provider and the hospital are entitled to. Those that follow up on unpaid claims are going to have to be extremely persistent with efforts to get reimbursed. It is vital to your physician and to your job security. Just make sure that the service being billed is documented well, and then fight to end for the doctor that takes the time to document his/her services. For those that will not bill for services “because we won't get paid anyway” you need to change your attitude or change your profession. Coders need to take care in reporting every service that a billable health care professional provides. If the documentation does not support the service provided, code it to the best of your ability and enter it in your billing system at a zero charge so that you have a means to communicate financial loss to providers accurately. It is vitally important that a health care professional document accurately the service provided, not just for coding purposes, but for quality of patient care. OK, I will step down from my soap box now. I am serious about being the squeaky wheel, and pursue every possible avenue for the payment your health care professional deserves.

 

[LanaW]

Thank you!!!!!

 

[cgallimore]

I agree with M.J. - stay up on that soap box!! That's the only way things will change. We have to continue to be that 'squeaky wheel' & be vigilant. I'm from NC too and know exactly what you are dealing with. It is very frustrating. Good luck.