Author Topic: In CA (Medi-Cal) billing forROOM/BOARD AND ROUTINE CARE SINCE THE 6/2016 CHANGES  (Read 596 times)

HospiceEmese

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Since Medi-Cal made the changes in 6/2016.  I am having issues getting some of my claims paid. 

Ex: If a patient only has Medi-Cal and I bill routine care services on one claim and bill room and board on a separate claim the room and board gets denied for RAD 0168 ( More than one type of hospice care not payable for any recipient on the same or overlapping dates of service)  however these are two different types of service. 

We never had any problems getting these paid until Medi-Cal eliminated the use of HCPC codes for hospice.

Another issue, if a patient has Medicare part B only, Medi-Cal pays for routine hospice care, no need for a denial (per their manual) however they are denying requesting the medicare denial.

Michele

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I don't bill Medi-Cal, but on the second issue are you just missing a modifier?  The GY modifier indicates it is a non-covered Medicare service. 

As for the first issue, have you contacted Medi-Cal to ask them to explain the denial?  Can they not be billed on the same claim?  It sounds like it is due to the change they have in codes so I would start with a phone call to them to see if they can point you to something that will explain how the claims must now be coded.

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