Alerts

IRHC Changes to Billing

1/30/2018

PDF Version


TO: Independent Rural Health Clinics (IRHC) Providers

 

Effective for date of service April 1, 2018 or later, Alabama Medicaid (Medicaid) will require IRHCs to bill the exact or closest procedure code for the service being performed. During claims processing, submitted procedure codes will systematically roll into a T1015 procedure code to generate an encounter rate.  

 

How can an IRHC help ensure they receive payment?

·         Itemize the billing to services they are performing

·         Utilize the Current Procedure Terminology (CPT) Code Book

·         Document medical support in the recipient chart to justify level of care billing

·         Submit a clean claim (refer to Provider Manual Chapter 5)

 

Note* Billing for services within the encounter must be under the IRHC National Provider Identifier (NPI).

 

What services are billable and reimbursable outside of the encounter rate?

·         Vaccines for Children (VFC) 18 years and under

·         Deliveries

·         Surgeries with place of service 21 or 22

·         Labs

·         Technical component for:

o   Electrocardiograms (EKG’s)

o   Radiology

·         Intrauterine Devices (IUDs)

·         Smoking cessation products (under family planning)

 

Note* Billing for services outside the encounter must be under the non IRHC National Provider Identifier (NPI) and on a separate claim.

 

Medicaid commits to ensuring a smooth transition:

·         Medicaid welcomes providers with interest in testing.  For questions or assistance regarding testing, please email the Medicaid Fiscal Agent at AlabamaIRHCTest@groups.ext.hpe.com.

·         Dates for testing will be March 1-16, 2018, for claims with dates of service December 1, 2017, or later.

 

For questions regarding the IRHC reimbursement, please contact the Medicaid Fiscal Agent, Provider Assistance Center at 1-800-688-7989.