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IV.
Documentation
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 Billing
Procedures
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MAA
sets the reimbursement coverage and limitation policies
for DC's Medicaid program. Policies that govern Medicaid
allow for the payment of a variety of medical services.
The
HealthCheck Medicaid Provider Billing Manual
(Appendix 1):
- Describes
how to complete and file claims for reimbursement for
Medicaid.
(Note: Medicaid contracts with a
private company to pay claims; this company is referred
to as the “Medicaid fiscal agent”).
- Furnishes
the Medicaid provider with policies and procedures needed
to receive reimbursement.
- Contains
descriptions and instructions on how and when to complete
forms, letters, or other documents.
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Types
of Reimbursement
- Fee-for-service – the
provider is paid a fee for each procedure performed
and billed.
- Cost-based
reimbursement ("per diem" or "encounter" rate) – based
on the provider’s
actual cost for rendering services to Medicaid member.
- Capitation
reimbursement -- A MCO is paid
a fixed amount
each month for each recipient (per capita) who is enrolled
in its
organization.
Member
and Billing Issues
This
concludes the Documentation section.
The next page contains Review Questions for the
information presented in this module.
After completing the review questions, you have completed the course!
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