Responses Nursing home delivery- Georgia M'Caid
Scott Yarberry, CPO
Description
Collection
Title:
Responses Nursing home delivery- Georgia M'Caid
Creator:
Scott Yarberry, CPO
Date:
10/6/2005
Text:
Greetings,
First let me say I did not mean to confuse M'care regions with M'caid. I
should have stated I am in Georgia (which is in region C). Patient is
strictly GA M'caid only. Anyway, I received three responses and the
fourth was a verbal confirmation after finally getting through to
someone at GA M'caid. Names deleted for confidentiality. Thanks
Original Post: As no one will/can return our call from Region C Medicaid
office (they
are at a regional meeting), I ask my colleagues for their knowledge. I
have a M'Caid patient in a skilled nursing bed at a rehab NH receiving
P.T. 3x week. Can I bill M'Caid if I deliver her prosthesis to her or
do I wait until she is discharged or other?
Responses:
I'm not sure Medicaid is a region. It is state by state. My
interpretation is that in no way, short term or long term, does Medicaid
pay for O&P devices while in a SNF. Please post responses, especially I
am incorrect!
under Medicare you can bill for a prosthesis but not supplies ie socks,
shrinkers. m'caid may be different. the Medicare 2 day rule specifies
that there are certain prosthetic L-codes that are billable, the
exclusion is supplies, provided that it is part of the pt's rehab
Medicaid is a state run federal program and not affiliated with Region
C. If your patient is on Medicaid and not Medicare, I assume they
follow the same rules as Medicare and you can provide the prosthesis at
the SNF and bill it to Medicaid, as the codes should still be exempt
with them as well. But, if they follow Medicare exactly, only the
prosthesis is billed to Medicaid and the socks and shrinkers (and post
op casts) would be billed to the SNF.
CALLED MEDICAID SPOKE WITH ***** WHO ASKED A NURSE CASE MANAGER WHO SAID
THAT IF THE PT IS COVERED BY MEDICAID AND THE ITEMS THAT WE ARE BILLING
FOR ARE A COVERED SERVICE THEN WE ARE OKAY TO BILL MEDICAID. THERE ARE
NO RULES AS FAR AS # OF DAYS IN AN SNF OR WHEN THEY ARE BEING DISCHARGED
First let me say I did not mean to confuse M'care regions with M'caid. I
should have stated I am in Georgia (which is in region C). Patient is
strictly GA M'caid only. Anyway, I received three responses and the
fourth was a verbal confirmation after finally getting through to
someone at GA M'caid. Names deleted for confidentiality. Thanks
Original Post: As no one will/can return our call from Region C Medicaid
office (they
are at a regional meeting), I ask my colleagues for their knowledge. I
have a M'Caid patient in a skilled nursing bed at a rehab NH receiving
P.T. 3x week. Can I bill M'Caid if I deliver her prosthesis to her or
do I wait until she is discharged or other?
Responses:
I'm not sure Medicaid is a region. It is state by state. My
interpretation is that in no way, short term or long term, does Medicaid
pay for O&P devices while in a SNF. Please post responses, especially I
am incorrect!
under Medicare you can bill for a prosthesis but not supplies ie socks,
shrinkers. m'caid may be different. the Medicare 2 day rule specifies
that there are certain prosthetic L-codes that are billable, the
exclusion is supplies, provided that it is part of the pt's rehab
Medicaid is a state run federal program and not affiliated with Region
C. If your patient is on Medicaid and not Medicare, I assume they
follow the same rules as Medicare and you can provide the prosthesis at
the SNF and bill it to Medicaid, as the codes should still be exempt
with them as well. But, if they follow Medicare exactly, only the
prosthesis is billed to Medicaid and the socks and shrinkers (and post
op casts) would be billed to the SNF.
CALLED MEDICAID SPOKE WITH ***** WHO ASKED A NURSE CASE MANAGER WHO SAID
THAT IF THE PT IS COVERED BY MEDICAID AND THE ITEMS THAT WE ARE BILLING
FOR ARE A COVERED SERVICE THEN WE ARE OKAY TO BILL MEDICAID. THERE ARE
NO RULES AS FAR AS # OF DAYS IN AN SNF OR WHEN THEY ARE BEING DISCHARGED
Citation
Scott Yarberry, CPO, “Responses Nursing home delivery- Georgia M'Caid,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/225629.
