Wiki Global Billing

[k_isabel04]

We have alot of patient's w/ Ins and MCD. Insurances we are to bill global, what if pt has MCD 2ndry? If patient owes deductible, once Insurance processes claim we have to file to MCD but change the global code to delivery only and will only get paid for delivery fee and not the visits.
How does this work?

 

[dan528i]

If your ptn has deductible, then they most likely have commercial insurance. In that case they are not allowed to have medicaid. Medicaid is for ptn who can not afford medical coverage. (In theory). But i m pretty sure that ptn with commercial ins. are not supposed to have Medicaid coverage and deductible is ptn responsibility.

 

[Beachbum32459]

I have tons of OB pts that do have commercial ins w/Medicaid Florida 2nd. This is due to the commercial ins not covering maternity. But..we are required to file to the commerical carrier get the denial then file to Medicaid. Unfortunetly I do not know how much of a reimbursement we get as I work for a very large corporate medical group and don't see that end of the process, but what little I do know is that we do get paid on the global delivery as Fl. Medicaid has added 59400 to their fee schedule. Sorry not much help.

 

[nutter98]

I worked for an OB office in Ohio and often came across this situation. The managed care Medicaids would allow me to send the claim with the global charge and primary EOB and a list of all office visits, delivery, and post partum care. They would then determine how much they would have paid. If they would have paid more than the primary paid then they would pay us the difference. If they would have paid less then we had to write off the balance. Regular Medicaid required that we break down the global using 9921X for each visit, the delivery code, and the post partum code. These items added together should equal the total global fee (I always had to figue out how much to charge for each visit and not use the standard charge amounts). I know it is difficult but that is how I had to do it.