Medical Billing Forum

Billing => Billing => Topic started by: jdorn on March 03, 2015, 01:52:23 PM

Title: Pregnancy Medicaid
Post by: jdorn on March 03, 2015, 01:52:23 PM
I work at an urgent care - in the past if a patient presents pregnancy Medicaid we simply qualify them for 75% compassionate care and do not file the Medicaid.  We have new management and things are changing...   One thing they question is what pregnancy Medicaid will cover I found this on-line

" Pregnant women receive care related to the pregnancy, labor, and delivery and any complications that may occur during pregnancy, as well as perinatal care for 60 days post partum. States have the option to provide pregnant women with full Medicaid coverage, or they may elect to limit coverage to certain pregnancy-related services.  "

My question for you is "any complications that may occur during pregnancy" really ANY? I mean if a patient comes in with the flu would pregnancy Medicaid cover this?  I would like a list of specific things they may or may not cover but I cannot locate anything helpful.. I am in NC.
Title: Re: Pregnancy Medicaid
Post by: Merry on March 03, 2015, 05:00:49 PM
flu would not be related to the pregnancy. Just as a UTI would not come under the "pregnancy" rules or global fee
Title: Re: Pregnancy Medicaid
Post by: kristin on March 03, 2015, 05:25:35 PM
I would look at it like any complications during pregnancy, that DIRECTLY RELATE to the patient being pregnant...and nothing else. In other words, would the patient have the problem they are presenting with if they weren't pregnant, or is it only present because they are pregnant?
Title: Re: Pregnancy Medicaid
Post by: tinaraynor on March 03, 2015, 06:37:55 PM
In Maryland, pregnant women receiving Medicaid coverage get the full-package Medicaid, so benefits are not limited to pregnancy only (urgent care could be covered). Does NC  Medicaid offer the same? If so, urgent care may be billable.