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Medicaid Reimbursement

By Diana Buskirk posted 05-04-2010 08:15 AM

  
  I am a relatively new Psych. NP I have been working in a private practice for about 1 1/2 years. I was recently credentialed with private insurances as well as medicaid (within the last 4 months). Yesterday we were informed by medicaid that patients can only be seen 4 times a year by the NP.(the office manager had called on denied claims). The rest of the time they would have to pay out of pocket. This seems absolutely ludicrous to me!
  Has anyone else had this problem? At least 1/3 of our cliental are medicaid. The only solution is to have to Psychiatrist see only medicaid patients, and for me to see medicare and private insurance patients. Anyone else have this problem and what did you do? Could the person who credentialed me have done something wrong with regard to the paperwork?
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Jamie Wiles
01-03-2013 01:43 PM

I am unsure what state you are from, but Medicaid may be state specific. I am from Ohio and as far as I know we have never came across an issue such as this. In fact, our PMHNPs and PMHCNSs see a majority of clients that are on Medicaid. Currently it is the only insurance credentialing I am on working in a CMHC. I would look at your state's medicaid policy.

David Whittaker
04-04-2012 09:06 PM

I have not billed KY Medicaid for years. I work at the Louisville VA so I don't have to worry about all those Medicaid rules. Most medicaid rules are made by the states and as you might expect there are many differences from state to state. KY has had the 4 visits with Psych NP for a long time now. Good luck getting that changed.

Diana Buskirk
05-26-2010 06:52 PM

As far as I know it's state specific. The person who did my credentialing should have known the rules & regulations! I could have continued under the Doctor. The private insurances and medicare don't have such restrictions. NP's in the "medical" field are able to see their pts. as often as needed. I did not think they could discriminate between "medical" and "psych!" Here in KY NPs can only write for 2 weeks of narcotic meds at a time, BUT I can't see them q 2 weeks! I use the doc's RX pad that she signs. Hope that helps! Anyone with any such problems?

Patricia Comerford
05-26-2010 12:19 PM

Is this national or state specific? I am just being paneled for Medicaid. Not good news.