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Response from the Department of Health and Human Services

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Updated: 2/11/2013 2:20 pm
Being responsible fiscal stewards and in the best interest of Nevada citizens, Nevada Medicaid undergoes a multitude of quality assurance surveillance reviews and audits to ensure that Medicaid payments are done accurately. A recent audit revealed that some Obstetricians had incorrectly billed for services. The incorrect billing only relates to illegal non-U.S. citizens who are only eligible for Medicaid payment for emergency services.

Illegal non-U.S. citizens are not eligible for Medicaid. However, Medicaid has a provision that allows OB physicians to bill for medically necessary emergency deliveries. In these instances OB’s can bill and be reimbursed for the delivery only, not for prenatal nor postpartum. The audit revealed that some OBs submitted claims using a “global code” which includes prenatal care, delivery and post-partum care. Only Medicaid beneficiaries are covered for these services. Illegal non-U.S. citizens are not.

Medicaid is now recouping the overpayment that was made. Physicians are encouraged to resubmit their bill using the correct code to receive payment for deliveries. An “Urgent” notification was posted on the Medicaid Provider website several weeks ago about the audit discovery and the recoupment process. In addition to that communication, letters and phone calls are going out to all physicians involved in the overpayment. Again, OBs that re-submit claims for delivery only will receive payment.

If the recoupment activity creates a hardship for any physician, they are encouraged to call (775) 335-8500, to establish a payment plan. If a provider or medical office staff have questions about coding, they can call (775) 684-3748.

Our sincere hope is that through the Medicaid website, instruction letters and phone calls, and this news story, our doctors will understand the process to receive the correct payment.



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