When we bill the Medicare side of BCBS MSHO plans, we bill Medicare PDGM guidelines. But if we are seeing them for services not covered under Medicare, then we bill per visit like we have always done. I don’t see payments for our October
claims yet, but those should be coming soon, so I have not had any of these problems. From the screen shot of the contract updates it says:
Medicaid clients who are not eligible for Medicare services should not be billed like PDGM but per visit and under those guidelines.
Alicia Schmidt
Accounts Receivable Lead
2715 Hwy 29 S Ste 103, Alexandria, MN, 56308
Office: 320-759-3340 | Fax: 320-759-1275
knutenelson.org | Nonprofit Senior Lifestyle Provider
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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Friday, November 19, 2021 2:57 PM
To: billers@list.mnhomecare.org
Subject: Re: blue plus medicaid claims
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External Email |
To me - this all has to do with the patient's plan/policy. I'm just sharing what was shared here before that the blue cross MSHO coverages are supposed to be billed as PDGM. Again - I'm sure
there are people here who've been doing this for way longer than me and probably have way more knowledge on this, but I used to bill out MSHO blue cross policies as fee for service and I switched with the July 1 start date as listed in that image that was
shared in the image below and I haven't had any denial issues. So I'm just sharing what has been working on my end.
UCare on the other hand, their MSHO is still fee for service, so each insurance company is different.
Crisa Mortenson
Billing Officer
Phone:
218-843-3852
Fax : 218-843-2311
Email: crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700
Hallock, MN 56728
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M <Tracy.Salin@fairview.org>
Sent: Friday, November 19, 2021 2:51 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: blue plus medicaid claims
I believe that to be false. You should never bill pdgm billing for non medicare qualifed services. To my knowledge…… that is the language I think that was lost.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mary Hanson
Sent: Friday, November 19, 2021 2:45 PM
To: billers@list.mnhomecare.org
Subject: RE: blue plus medicaid claims
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I am also confused.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Vig,Terisa
Sent: Friday, November 19, 2021 2:37 PM
To: billers@list.mnhomecare.org
Subject: Re: blue plus medicaid claims
So, am I missing something? Even if the person does not meet Medicare guidelines, we still are to bill RAPS and claims?
Terisa Vig
Patient Account Representative
RiverView Health Home Care
tvig@riverviewhealth.org
218-281-9240
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Hanson,April <April.Hanson@PerhamHealth.org>
Sent: Friday, November 19, 2021 12:18 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] Re: blue plus medicaid claims
Good afternoon,
We are also having a few claims starting to deny I believe the dates of service were Sept and Oct. I called BC and had them sent back for review. The rep had reviewed
the claims with me and agreed nothing had changed in the way we were billing. Previous claims for the same patient had paid just fine. I'm not sure what the issue is, but just wanted to let you know we are experiencing the same thing as of recently. If anyone
does hear of an issue please let us all know. I plan to continue calling on them when I find these denials, but it would be really great to be able to prevent the denial in the first place. Happy Friday everyone!
April Hanson
Patient Accounts
Perham Living
Ph: 218.347.1894
F: 218.347.1885
Dedicated to health and wellness throughout life.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Mortenson,Crisa <Crisa.Mortenson@kmhc.net>
Sent: Friday, November 19, 2021 11:34 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] Re: blue plus medicaid claims
Well it states in the information that it applies to MSHO patients, you said that's what you're billing, correct?
Again - someone out there must have more experience than I do in this, but as soon as I saw this, I switched over ALL my MSHO patients to PDGM and haven't had any issues
getting paid on them.
Crisa Mortenson
Billing Officer
Phone:
218-843-3852
Fax : 218-843-2311
Email: crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700
Hallock, MN 56728
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M <Tracy.Salin@fairview.org>
Sent: Friday, November 19, 2021 11:29 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: blue plus medicaid claims
No they don’t. I have never billed pdgm to Medicaid for any advantage plan. But am I supposed to now?
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Friday, November 19, 2021 11:20 AM
To: billers@list.mnhomecare.org
Subject: Re: blue plus medicaid claims
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But medicaid follows medicare guidelines, correct? I would think you bill them out the same way. I could be wrong.
Crisa Mortenson
Billing Officer
Phone:
218-843-3852
Fax : 218-843-2311
Email: crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700
Hallock, MN 56728
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M <Tracy.Salin@fairview.org>
Sent: Friday, November 19, 2021 11:18 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: blue plus medicaid claims
Right but I am not billing medicare qualified claims. I am billing Medicaid qualified claims.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Friday, November 19, 2021 11:15 AM
To: billers@list.mnhomecare.org
Subject: Re: blue plus medicaid claims
|
|
Crisa Mortenson
Billing Officer
Phone:
218-843-3852
Fax : 218-843-2311
Email: crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700
Hallock, MN 56728
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M <Tracy.Salin@fairview.org>
Sent: Friday, November 19, 2021 10:56 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: blue plus medicaid claims
The non medicare ones too?
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Friday, November 19, 2021 10:47 AM
To: billers@list.mnhomecare.org
Subject: Re: blue plus medicaid claims
|
|
Are you billing them PDGM? That started July 1.
Mine are paying just fine.
Crisa Mortenson
Billing Officer
Phone:
218-843-3852
Fax : 218-843-2311
Email: crisa.mortenson@khmc.net
1010 S Birch Ave. P.O. Box 700
Hallock, MN 56728
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Mary Hanson <mhanson@rvhci.com>
Sent: Wednesday, November 17, 2021 12:38 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: blue plus medicaid claims
I have been having the same problem. Everything was fine until mid-July. They take forever to process and now started denying. I called and they are in the process of reprocessing the claims so I don't
know yet if they are going to pay or not.
Very frustrating; especially when I haven’t changed anything in how I bill them.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Salin, Tracy M
Sent: Wednesday, November 17, 2021 12:07 PM
To: billers@list.mnhomecare.org
Subject: blue plus medicaid claims
Hey I am having all my claims deny for my blue plus msho clients when I bill the Medicaid side. I bill t codes to payer id 00562. Every one of my msho client claims deny. I call, they reprocess and pay them.
I cannot figure out why this continues to happen. I have aske for help in resolving this issue that has been occurring for this entire year but blue plus is not responsive at all.
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