How to Deal With Medicaid For the Medical Biller

By Angel Bean

When a patient has medicaid it can sometimes pose some problems with getting the medical claim paid. Here are some special medicaid scenarios for the medical biller.

When you are dealing with medicaid HMO’s prompt the patient to appeal to the carrier if the bill is denied for no authorization for medical services. This applies especially when the carrier is HIP.

In one situation the patient had medicaid and GHI insurance and the patient died and left no estate and medicaid had soaked up all savings and other monies. If New Jersey medicaid cannot be filed you must accept the GHI insurance payment as payment in full. If the patient had medicaid then medicaid would have liquefied her assets for reimbursement. So in this circumstance you would call medicaid for information, call the nursing home and ask what insurance the patient had and order a duplicate EOB or explanation of benefits from the insurance company so you know how much money to expect and how much to write off.

The Medicaid pre-pass program this means that even if you are denied New York State medicaid as a medicaid HMO, for this example it will be Home First, the anesthesia insurance claim will still go to New York State medicaid because some medicaid HMO’s do not reimburse or provide for anesthesiology services.

Ask the patient to put in an application for medicaid if the date of assistance was a crisis and they have no insurance. Call the insurance company and explain to them there could be no pre-authorization as it was for a crisis service. Before you do that make sure that the procedure was billed as an outpatient if the patient was an outpatient and inpatient if the patient was an inpatient. For an crisis service you should also see if the place of service was in or out of network as well.

At the doctor’s request you should send a medical client to the collections department at the doctor’s courtesy rate regardless of whether or not the patient has a medicaid hmo (health maintenance organization). We have to contact the carrier, especially if the traveler is HIP, and send a letter of grievance.

When you have both Medicaid and Medicare on an insurance claim Medicaid is the primary health plan and Medicare is secondary insurance. You should file to Medicare after Medicaid. For medicaid accounts you would check medicaid online at the medicaid website to see if the service comes up as an eligible emergency service under medicaid. Then add the medicaid identification number and lower the fee and file to medicaid on both or all accounts that the patient has with you.

For medicaid cases you call the client and have them call the hospital’s inpatient or outpatient billing division to get a correct copy of their medicaid number. The client then calls the hospital to confirm their medicaid number and then calls us back with that information.

Occupied Bedmaking Skills for Certified Nursing Assistants
Since some patients are in bed all day long, it is important to know how to make up the bed so that their bed linens remain clean. A clean patient is a healthy patient. Making up the bed with the patient in it is something that can be done easily and safely. Here is how to put fresh bed linens on an occupied hospital bed.

Please visit Occupied Bedmaking Skills for Certified Nursing Assistants at http://www.associatedcontent.com/article/2831758/occupied_bedmaking_skills_for_certified.html After you click the link above you will be taken to a site that show you how to care for the elderly by changing their bed linens to keep them clean and healthy.

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