Preparing to Bill Medicaid

7,634 views
7,167 views

Published on

Published in: Business, Economy & Finance
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,634
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
17
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Preparing to Bill Medicaid

  1. 1. What you need to know about billing to Medicaid Beverly Remm Director of Billing Orion Healthcare Technology
  2. 2. <ul><li>Medicaid Provider Enrollment </li></ul><ul><ul><ul><li>National Provider Identifier </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Obtaining an National Provider Identifier Number </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>What is an NPI? </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Medicaid Enrollment Process </li></ul></ul></ul><ul><li>Options for Billing to Medicaid </li></ul><ul><ul><ul><li>Using a State System </li></ul></ul></ul><ul><ul><ul><li>Outsource Billing Service </li></ul></ul></ul><ul><ul><ul><li>Billing Software </li></ul></ul></ul>Preparing to Bill to Medicaid | May 4, 2011
  3. 3. Preparing to Bill to Medicaid | May 4, 2011
  4. 4. <ul><li>If you provide services to patients who are Medicaid eligible or already have Medicaid coverage. </li></ul><ul><li>If you would like to start providing services to Medicaid eligible clients and receive reimbursements from Medicaid for those services. </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  5. 5. Preparing to Bill to Medicaid | May 4, 2011
  6. 6. Preparing to Bill to Medicaid | May 4, 2011
  7. 7. <ul><li>Mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) </li></ul><ul><li>Issued by Center for Medicaid and Medicare (CMS) </li></ul><ul><li>A Unique 10 digit Identifier for healthcare providers (facilities and individuals) </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  8. 8. <ul><li>Licensed individuals and entities that provide health care services </li></ul><ul><li>Providers that are going to bill for health care services </li></ul><ul><li>Any health care provider that has a taxpayer identifying number. </li></ul><ul><li>Who should not apply for an NPI Number </li></ul><ul><li>Groups, partnerships, or corporations. </li></ul><ul><li>Physicians who have opted out of government medical programs. </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  9. 9. <ul><li>Website: https://nppes.cms.hhs.gov/NPPES/ </li></ul><ul><li>- Online application or download forms </li></ul><ul><li>- Have your application information ready </li></ul><ul><li>Receive your NPI number typically in 1-2 weeks </li></ul><ul><li>Call NPPES at 1-800-465-3203 for assistance </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  10. 10. <ul><li>Every State Medicaid program will have different requirements and processes for Provider Enrollment. </li></ul><ul><li>Application forms </li></ul><ul><li>Copies of documentation (example: W-9, license certification, etc.) </li></ul><ul><li>Signed Provider Agreements </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  11. 11. <ul><li>Many state Medicaid programs will have documents and instructions online. </li></ul><ul><ul><li>Listing requirements </li></ul></ul><ul><ul><li>Steps for enrolling </li></ul></ul><ul><li>Billing services can assist with process </li></ul><ul><ul><li>Completing forms </li></ul></ul><ul><ul><li>Gathering the required documents </li></ul></ul><ul><ul><li>Follow up on application status </li></ul></ul>Preparing to Bill to Medicaid | May 4, 2011
  12. 12. <ul><li>Once you have become a Medicaid provider your next step is to become familiar with Medicaid guidelines and billing requirements. </li></ul><ul><li>Billable and Payable Service Codes </li></ul><ul><li>Current Fee Schedules </li></ul><ul><li>Medicaid Billing guidelines </li></ul><ul><li>Timely Filing Limitations </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  13. 13. <ul><li>Based on your provider enrollment contract there are some standard questions that you should ask your State Medicaid contact: </li></ul><ul><li>How can I verify client eligibility? </li></ul><ul><li>Do I need authorizations for services rendered? </li></ul><ul><li>What are Medicaid’s Claims Submission guidelines and options? </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  14. 14. Preparing to Bill to Medicaid | May 4, 2011
  15. 15. <ul><li>Medicaid State Software Programs </li></ul><ul><ul><li>A software system offered by your State Medicaid to submit provider billing and claim information </li></ul></ul><ul><li>Outsource Services </li></ul><ul><ul><li>A contracted service to track and submit your billing and claims for Medicaid, insurance, etc. </li></ul></ul><ul><li>Billing Software System </li></ul><ul><ul><li>A software application used to track and submit your billing and claims for Medicaid, insurance, etc. </li></ul></ul>Preparing to Bill to Medicaid | May 4, 2011
  16. 16. <ul><ul><li>Pros </li></ul></ul><ul><ul><li>Free software </li></ul></ul><ul><ul><li>Enter specific information needed by Medicaid </li></ul></ul><ul><ul><li>Cons </li></ul></ul><ul><ul><li>Limited information output </li></ul></ul><ul><ul><li>Duplication of data entry </li></ul></ul><ul><ul><li>Extra time spent on support needs </li></ul></ul>Preparing to Bill to Medicaid | May 4, 2011
  17. 17. <ul><li>What you should expect from your Billing Service </li></ul><ul><li>Manage submission of all services to Medicaid </li></ul><ul><li>Knowledgeable with State and Medicaid guidelines </li></ul><ul><li>Assist with follow up on denied or unpaid claims </li></ul><ul><li>Clear understanding of your agency’s goals and needs </li></ul><ul><li>Provide detailed reports for services and claims </li></ul><ul><li>Work with insurance companies on claims issues to ensure payment on claims </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  18. 18. <ul><li>What to look for in a Billing Software System </li></ul><ul><li>HIPAA ready </li></ul><ul><li>Patient Privacy </li></ul><ul><li>Regular updates to software for industry compliance </li></ul><ul><li>Personal and reliable customer support </li></ul><ul><li>Easy to use </li></ul><ul><li>Electronic Claims Submission </li></ul><ul><li>Experience in your specialty and services </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  19. 19. <ul><li>Before you can Bill to Medicaid: </li></ul><ul><li>Obtain an NPI number </li></ul><ul><li>Enroll as a provider with Medicaid </li></ul><ul><li>Become familiar with Medicaid provider guidelines </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  20. 20. <ul><li>When you are ready to bill for Medicaid: </li></ul><ul><li>Take time to establish or review your organizations billing policy and procedures </li></ul><ul><li>Choose the best method of submitting claims to Medicaid to fit your needs. </li></ul><ul><li>Using the state’s system </li></ul><ul><li>Outsource Billing Service </li></ul><ul><li>In House Billing Software </li></ul><ul><li>Implement and monitor your new billing program or service </li></ul><ul><li>Use available resources or experienced services to assist you </li></ul>Preparing to Bill to Medicaid | May 4, 2011
  21. 21. <ul><li>Please contact Orion Healthcare Technology today if you have any questions. </li></ul><ul><li>Call Us: 1-800-324-7966 </li></ul><ul><li>Visit: www.MyAccuCare.com/billing </li></ul>Preparing to Bill to Medicaid | May 4, 2011 1001 N. Fairfax Street., Ste. 201 Alexandria, VA 22314 phone: 703.741.7686/800.548.0497 fax: 703.741.7698/800.377.1136 www.naadac.org • [email_address] Chris Campbell: chris@naadac.org 1016 Leavenworth Street Omaha, NE 68102 phone: 402.341.8880 fax: 402.341.8911 www.myaccucare.com • info@orionhealthcare.com Emily Haverty: ehaverty@orionhealthcare.com

×