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