Practice Management

  • 1.  Medicaid MO

    Posted 02-12-2023 16:51

    The MO Medicaid management is denying payment for US performed in conjunction with an office visit (MFM or generalist) on the same day of service.   Needless to say, this will compromise care and access for our patients

    Have any of you had to deal with this? or have suggestions?

    Thanks
    --

    Debra Guinn MD, FACOG

    Professor of Obstetrics and Gynecology

    Maternal Fetal Medicine Division Director

    Obstetrical Services Medical Director

    Dept. of Obstetrics, Gynecology and Women's Health
    University of Missouri School of Medicine

    500 N Keene Ave, Suite

    Suite 406

    Columbia, MO 65203

    Phone:  573-817-3306

    New email:  dagck5@umsystem.edu

     



  • 2.  RE: Medicaid MO

    Posted 02-12-2023 23:14

    Hi Debra,

    This is not a common issue. It would help to make sure there are no contractual restrictions to billing both on the same day. Alternatively, it is worth appealing the denial, indicating that providing the 2 services on the same day is consistent with best practice and in line with diversity and inclusion for patients who would otherwise be challenged by having to come on separate days. Make sure to attach modifier -25 to the E/M service to indicate it is a distinct service from the ultrasound. If this remains an issue, please submit this concern at the SMFM advocacy website https://smfmadvocates.org/

    Fadi



    ------------------------------
    Fadi BSAT, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
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    Original Message