FQHC billing question : Nursing visits in VT
I have a question on billing out Nursing Visits (re: dressing changes, suture removals, etc) currently we enter these types of visits in our system but do not bill them to insurance companies. As a FQHC can we bill these types of services to Medicare and Medicaid and if so, can you advise us on how what the guidelines would be as to who/what needs to be recorded in patients chart and if we would bill using the revenue code for Medicare or bill to NHIC, with Medicaid the T1015 or fee for service?
Thanks for the note. To be clear, there is distinction between Medicare and Medicaid on this topic. UGS/NGS Medicare payment is NOT available for nurse visits. This is incontrovertible. However, certain states (e.g., Vermont and Connecticut), have language within the Medicaid FQHC manuals which clearly affords payment opportunity for services rendered “incident to” a core provider. The language for each state is unique so take a look yourself via the following URL. The T101, not fee for service, would be appropriate as this is what triggers encounter rate payment.
http://www.hrsa.gov/reimbursement/states/Vermont-Medicaid-Covered-Services.htm