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Medicaid billing guidelines

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Due to the nature of the program, Medicaid billing rules vary from state to state. Each state Medicaid program usually has its own ABN, for instance. (Here’s Oregon Medicaid’s official ABN and a notice of non-coverage that complies with Arizona statute.) That said, here are some general Medicaid billing guidelines from CMS: 

  • “Bill only for covered services”
  • “Ensure beneficiaries are eligible for services where they are furnished”
  • “Ensure medical records are accurate, legible, signed, and dated”
  • “Return any over payments within 60 days”

Keep in mind that because both the federal and state governments have their hands in the Medicaid pot, “Medicaid claims must adhere to both federal and state guidelines.” In other words, if you find conflicting instructions between your state guidelines and federal guidelines, you must adhere to the strictest guideline. 

Furthermore, when a patient has coverage outside of Medicaid, the provider should bill the other payer first. Take a look at some advice from that same billing and coding website: “Note also that Medicaid is officially the payer of the last resource for a claim, meaning that if a person has any other health coverage for services rendered, those institutions should be billed before Medicaid.”