ED Coding and Reimbursement Alert

Don’t overlook this chance to get some payment for otherwise uncollectable accounts.

Depending on your location, you may have to deal with a significant patient mix of undocumented aliens without insurance or means to pay their bills. These balances can be very hard to collect, but there may be at least some help available.

Here’s the deal: Back in December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173) (MMA), which included Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens.

The law required the Secretary of Health and Human Services to directly pay eligible hospitals, physicians, and ambulance providers (including the Indian Health Service and Indian tribal organizations) for their otherwise unreimbursed costs of providing emergency medical services to undocumented aliens, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.

Is your state listed? Section 1011 provided $250 million each year for fiscal years 2005-2008 for payments to eligible providers. Although many states have exhausted the funds allocated to them, there is still some money left in others.

Congress expressly stated that the appropriations shall remain available until expended.

As of the Nov. 21, 2012 quarterly payment, 28 states have exhausted their Section 1011 funds. They are: Arkansas, Alabama, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Louisiana, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin.

The bottom line: If your state still has Section 1011 funds remaining, and you are struggling to obtain reimbursement related to care provided to undocumented aliens, it might be worth looking into tapping the Section 1011 funds , says Granovsky.

Check Out This Payment Chart

The following chart shows the timelines for payment of Section 1011 claims with recent dates of service:

Resources: The CMS website on Section 1011 program can be found at http://www.cms.gov/UndocAliens/.

There’s a link to the Section 1011 statute at http://www.cms.gov/UndocAliens/Downloads/sec1011.pdf and a copy of the Section 1011 Final Policy Notice at http://www.cms.gov/UndocAliens/02_policy.asp, which explains the program functions and methods such as (1) the general framework and procedural rules for submitting an enrollment application and payment requests, (2) general statements of policy, and (3) guiding rules for administering section 1011, explains Granovsky.