Home Health Billing with Blue Cross

[CIA_2019]

Hello all!

Does anyone have any experience billing BCBS for PDN services? How was the process? They are giving a run around because the patient has Medicare which does not cover home health services...

Any feedback / tips will help!

Thanks!

[Michele]

Medicare does cover home health services.  Is this something specific that isn't covered?  Maybe you will have to bill Medicare first to get a denial?  Or try the GY modifier if it is truly a non covered Medicare expense.

[CIA_2019]

Hello-

Can you give a little more detail on the GY modifier?

Thanks

[kristin]

Google is your friend in this situation. Type "GY Modifier" into Google, and you will get all the information you need.

[CIA_2019]

Awesome! Does the GY modified work if you are not in network with Medicare?

[Michele]

There is no "in network" with Medicare.  A provider is either a Medicare provider or not enrolled as a Medicare provider.  If they are not enrolled as a Medicare provider they are not supposed to treat Medicare patients.  A provider can be a Medicare provider who is Non Par.

[PMRNC]

Michele is correct..there is no in/out network really. But it's all about accepting assignment with Medicare. Non par providers can still accept assignment, a par provider MUST accept assignment and naturally those who could and have opted out can't bill Medicare at all.