Betty Posted Tue 29th of January, 2019 12:34:09 PM
PATIENT HAS COMMERCIAL INSURANCE PRIMARY DURING OB GLOBAL PERIOD FROM 5/4/18 THRU 8/31/18, THEY PICK UP STATE MEDICAID EFF 7/1/18 AS SECONDARY AND COMMERCIAL TERMS ON 8/31/18 . SO NOW HAS MEDICAID AS PRIMARY EFF 9/1/18, WE SAW PT 5 TIMES BEFORE MEDICAID BECAME PRIMARY: 5/17, 5/29, 6/21, 7/17 AND 8/14/18. IF WE BILL 3 E/M'S TO COMMERCIAL THEN DEDUCTIBLE WILL BE DROPPED TO PT IF I BILL 59425 WITH THE 5 VISITS WILL BE BILLED OUT WITH DATE 8/14/18 AND COMMERCIAL WILL PAY AND DEDUCTIBLE WILL GO TO MEDICAID 2NDARY AND THEY WILL PAY BUT THEN WHEN WE BILL THE SPLIT BILL TO MEDICAID FOR THE REMAINING BALANCE 9/1-12/19/18 FOR ANTEPARTUM , DELIVERY ONLY MEDICAID WILL REJECT FOR A GLOBAL BILL......(MEDICAID REQUIRES 4 VISITS AND DELIVERY FOR GLOBAL) DO WE NOT BILL THE COMMERCIAL AT ALL AND JUST BILL GLOBAL TO STATE MEDICAID? OR DO WE BILL THE 3 VISITS TO COMMERCIAL AND BILL THE REST SPLIT TO MEDICAID? HELP.....
SuperCoder Answered Wed 30th of January, 2019 07:10:13 AM
The focus here should be to save the deductible. If the patient undergone for the delivery to Medicaid, then it will be good to bill 4 visits and delivery for global to Medicaid for better reimbursement, and do not bill to commercial then. On the other hand, if Medicaid is ready to pay split and does not drop the deductible, then bill 3 visits to commercial. It is important to calculate the amount with the Commercial and Medicaid payer. It is suggested to contact the reimbursement department of payer and calculate the payment.
Hope this helps!