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Need a CPT for Medicaid member- Home health recetification service

Fion Posted Thu 07th of June, 2018 18:35:35 PM
We had experienced the over payment issue with Medicare, we have billed with G0179 for the home health re-certifcation form completion. However, the claim has been paid by the Medicare over two years, but recently we got the noticed from the Medicare, due to the Medicare did not receive claim from the home health agency, that's why the payment needs to be refunded back to the Medicare. I would like to verify the coding issue. I have larger amount was recouped by the Medicare, Should I send bill to the Medicaid to instead? Can you assist me on the coding? I really have no idea how to claim to medicaid for the HHA form completion. Can you advice? Thank you!
SuperCoder Answered Fri 08th of June, 2018 04:01:41 AM

Hi,

Please make your question more clear. Whether member wants to recertify for HH Recertification or you want a CPT code for Medicaid Home Health Services.

For recertification, Home Health providers need to be recertified annually by Dept of Health (DOH). If you provider is a Medicaid member, you should not send claims to Medicare.

For a Medicaid, you may bill code G0156 and the maximum units per day should not be more than 16 units.

Please let us know if this answers your question.

Thanks.

 

Fion Posted Fri 08th of June, 2018 08:54:23 AM
Thank you so much for the your answer! I 'm sorry for the confuse. Our provider is not the home health provider, so may not bill for the G0156. I would like to know there is any cpt code is reimbursable by the Medicaid, when the physician is completed the HHA form for the Medicaid beneficiary. I just found the answer www.codingahead.com, Please review it . Can you verify the topic for me? Will Medicaid pay for CPT codes G0179, G0180, G0181, G0182, 99374, 99375, 99377, 99378, 99379 and 99380 Medicaid will not reimburse an attending physician for certifying the home health plan of care. This is considered as already reimbursed to the attending physician through any evaluation and management services provided throughout the period of illness that the recipient is receiving home health care assistance. Please note: Medicaid would cover Home Health services provided by the Home Health Agency but not for physician who certifies the Home Health plan of care.
SuperCoder Answered Mon 11th of June, 2018 06:09:41 AM

Hi,

There are different rules of different states.

Each state:

  • Establishes its own eligibility standards
  • Determines the type, amount, duration, and scope of services
  • Sets the rate of payment for services
  • Administers its own program

We suggest you to get reimbursement guidelines of your state. Please read the following:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf

Thanks.

 

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