Pennsylvania Medicaid/Welfare INs

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Pennsylvania Medicaid/Welfare Ins

I was wondering if someone could shed some light on this insurance. I work for a group of nurse anesthetists, and in the past pennsylvania medicaid pays for their anesthesia services, but most of the time, I have to adjust off the payment because according to Pennsylvania Welfare, they do not pay for a CRNA. I have been told in the past they do pay. I have been in contact with our provider rep regarding this issue and she has not helped me or my administrator out at all.

The insurance plans include unison, medplus, gateway, and medicaid. The rejections codes mostly state "not a medical plan benefit" or "the procedure code is not payable under medicaid guidelines". We bill with ASA codes, so at first i thought this was the issue, it was not.

Is there anyone that could point me in a direction to let me know if medicaid pays for a Group of CRNA's. There is no anesthesiologist on cases and since we are a staffed group at the facilities, the facilities get paid but the anesthesia does not. The pt does not have a choice on who the anesthetist is. We have to eat the payments that reject. The services that anesthesia provides is for colonoscopies and endoscopies.

You can either contact me on the aapc website or email me at
Bravegirl0514@hotmail.com

Thanks so much
Julie, CPC-A
 

Rhonda Buckholtz CPC

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PA Medical Assistance will not pay for CRNA's. They credential them but only for payment in the instance that Medicare is primary. That is the only time they will pay (which usually translates into not much) for CRNA's.

People get confused because they will credential, they just don't pay.
 
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ok thanks, i am so confused on that, why would they credential them if they will not pay? Like you said, if in case medicare is primary, but they still dont, even if that is true. I appreciate your help, I understand it much better.

Thank you!
 

DOyola

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Are they doing this under supervision... what about your formulas or modifiers..

I found this powerpoint from a state of PA.. http://www.pana.org/Power%20Point%20Presentations/Understanding%20Anesthesia%20Billing%20-%20Ackler.pdf

You will have to try to get in contact w/the supervisor or another person w/more knowledge from your providers...

http://www.cms.hhs.gov/

http://www.pana.org/ Probably you know about this website Pennsylvania Association of Nurse Anesthetists

Hope this help you w/something...as I'm reading around it looks that they will pay but verify w/your providers...

ok thanks, i am so confused on that, why would they credential them if they will not pay? Like you said, if in case medicare is primary, but they still dont, even if that is true. I appreciate your help, I understand it much better.

Thank you!
 
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Rhonda Buckholtz CPC

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No, seriously, I live in PA and had CRNA's in my past practice... they do not pay for thier services. And the only modifiers ever recognized are RT, LT and 50, none of the CRNA modifiers.

I did a tremendous amount of research on this. I have a contact for a MA trainer if you need it.
 

DOyola

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Wow is very confusing and crazy when you are searching for info...thanks...they have all this modifiers and info about that and they don't pay for it? wow...for what do CRNA get paid for?...

No, seriously, I live in PA and had CRNA's in my past practice... they do not pay for thier services. And the only modifiers ever recognized are RT, LT and 50, none of the CRNA modifiers.

I did a tremendous amount of research on this. I have a contact for a MA trainer if you need it.
 

Rhonda Buckholtz CPC

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They get paid from all the other carriers, and paid pretty well for thier services. MA just does not recognize them on thier own unless they have Medicare primary. Then they will pay any deductibles or coinsurance if it fits in thier fee schedule.
 
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Thanks for all of the imput on this insurance... I showed this to the president of the group i do the coding for and he thought this was a very good post and very good reponses. I also agree. Thanks for all that responded and if any one else has anything to add or has any questions, you can always contact me on here or at Bravegirl0514@hotmail.com

Julie, CPC-A
 
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