Get Your Claims Paid – The First Time!
Let’s face it, Medicaid reimbursement has not kept pace with the cost of doing business. It is extremely unlikely that the rates will be increased anytime soon. Implementing a few simple procedures can save you time and money and allow your Medicaid reimbursement to go further. Medicaid reimbursement does not cover your cost to touch a claim once, let alone twice!
- Require eligibility verification at the point of scheduling and the point of service for all Medicaid members. Track eligibility related denials to educate staff and add accountability. Implementing this procedure does require that schedulers and front office staff are educated about the eligibility verification systems, the various benefit packages, the various plans, and requirements for certain benefit packages and coverage plans.
- Revise the financial class listings in your practice management system to mirror exactly the plan name as it is listed on the Medicaid eligibility verification systems. This will make it easier for staff to select the correct insurer. With the various MDwise plans, it is not uncommon for staff to select the wrong plan.
- Create a system to communicate when a member is enrolled in a special/limited benefit package that requires non-standard coding i.e., Package B members. Office supply stores charge about $40 for a custom red-ink stamp. When the member presents for care and eligibility is verified, if the member is Package B (or a member of some other special/limited plan) the charge ticket/encounter form/route slip is stamped. When the charge is entered, the big red “Package B” or “B” or “special coding” stamped on the ticket will alert the charge entry staff/coder to review the charge carefully and apply any special applicable coding. If you are trying to correct these claims on the back end, you are wasting staff resources and costing yourself money.
- Create a system to communicate services that require special coding for Medicaid claims, such as vaccines/immunizations. Medicaid requires that all vaccines/immunizations for children be reported with the primary diagnosis code of V20.2, not the vaccine/immunization specific diagnosis code. The next time you revise your charge ticket/encounter form/route slip, next to the vaccine/immunization specific diagnosis code in parenthesis include (use V20.2 for Medicaid). The doctor will not have to do anything differently but the staff will remember to use the correct primary diagnosis code for Medicaid members when they enter the claim.
- Newborn claims CANNOT be billed with the mother’s recipient ID number (RID); they must be submitted with the newborn’s RID number. In some instances the assignment of the RID number can take several months. In most cases the number has been assigned within 60 days but has not been disseminated to providers. To obtain a newborn RID number, contact HP Customer Service and provide them with the Case Number indicated at the bottom of the Web interChange eligibility transaction for the mother and the newborn’s date of birth. Using the Case Number they can determine all family members associated with the mother. Once the RID number is obtained, run eligibility on that number to obtain the spelling of the first and last name of the newborn, as indicated in the Medicaid system.
- The member’s name must be entered on the claim EXACTLY as it appears in the HP eligibility verification system i.e., Web interChange, even if it is spelled wrong, is different from the spelling/name on the member’s other insurance or Medicare card. Set up an alert in your practice management system to either flag the front office to mark the charge ticket/encounter form/route slip or to flag the charge entry staff to make sure the name is entered to match the Medicaid system.
