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Question:

A patient comes in and says they suffered a work related injury, but doesn’t give enough information to bill workers comp. What duty does the provider have to track down that info? 

 

Answer:

The rule is simple, patient is obligated to provide insurance information otherwise the patients becomes private pay. We had cases where the patient did not have any or lost insurance/case information. In this case you will have to contact the appointed attorney.

 

 

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Question:

When a Physician Assistant may be able to perform an initial visit?

The answer was provided by American Academy of Physician Assistants – www.aapa.org

Answer:

Under Medicare, PAs are able to perform initial visits and submit claims using their own NPI in most instances.

Certain instances in which the physician may be required to perform the initial visit include:

  1. In a Skilled Nursing Facility, the physician must perform the initial comprehensive visit – check here
  2. If it is the policy of the state or facility (if it is a facility) – Medicare defers to state law guidelines on covered services – check here
  3. In an office setting, if it is the intention to bill “Incident to” (all other “incident to” criteria must also be met) – check here

PAs may furnish services billed under all levels of CPT evaluation and management codes, and diagnostic tests, if furnished under the general supervision of a physician.

 

 

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Question:

Does Fidelis reimburse for home visit to DPM?

 

Answer:

Yes they do, but authorization is required and special credentialing must be performed.

 

 

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Question:

My claim was denied. Can I bill the beneficiary?

 

Answer:

 

Pay special attention to your Medicaid beneficiaries - Medicaid participating providers are prohibited from billing Medicaid beneficiaries for any amount, except for these conditions (see Newsletter Vol 11, #60):

  • Services are not covered and the beneficiary elected to receive the services with the knowledge that they were not covered. The beneficiary must agree in writing to be responsible for payment before the date of service.
  • A third party made a payment directly to the beneficiary.
  • The beneficiary is not eligible for Medicaid on the service date.

This policy can be found in Chapter 10-49 of the Administrative Manual. To access Chapter 10-49, click on the State DMAHS link on the home page of this website or request a copy of

Chapter 10-49 by contracting the Molina hotline at (800) 776-6334.

 

 

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Insights
April 2018