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What you need to know about billing to Medicaid Beverly Remm Director of Billing Orion Healthcare Technology.

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Presentation on theme: "What you need to know about billing to Medicaid Beverly Remm Director of Billing Orion Healthcare Technology."— Presentation transcript:

1 What you need to know about billing to Medicaid Beverly Remm Director of Billing Orion Healthcare Technology

2  Medicaid Provider Enrollment o 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 System o Outsource Billing Service o Billing Software Preparing to Bill to Medicaid | May 4, 2011

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4  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

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7  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

8  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

9  Website: https://nppes.cms.hhs.gov/NPPES/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 for assistance Preparing to Bill to Medicaid | May 4, 2011

10 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

11  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

12 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

13 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

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15  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

16 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

17 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

18 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

19 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

20 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

21 Please contact Orion Healthcare Technology today if you have any questions. Call Us: Visit: Preparing to Bill to Medicaid | May 4, N. Fairfax Street., Ste. 201 Alexandria, VA phone: / fax: / Chris Campbell: 1016 Leavenworth Street Omaha, NE phone: fax: Emily Haverty:


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