NARHC Forum
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| 5/17/2023 @ 12:08:00 PM
Post 1 of 7
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
We are located in Kansas and are a provider based RHC. We provide IUD and Nexplanon services for our patients. KanCare Sunflower, KanCare Aetna and KanCare UHC are not paying for the devices. We have been told we need to submit the device under POS 11, but use the non-RHC NPI. We're not sure we have a non-RHC NPI. Does anyone have any guidance on that? Also some other posts on this forum have mentioned having the vendor bill the patient insurance for the devices. What supplier are people using that will do that? Our supplier won't bill patient insurance. Any help anyone can give on this subject would be appreciated! Sherri Johnson, RHIT, McPherson Medical and Surgical Clinic 5/17/2023 @ 12:35:00 PM
Post 2 of 7
Contributor: Amy Schrag, Pratt Family Practice
Sherri, we are an Independent RHC in Kansas and we have had to stop providing IUDs to our Medicaid/Kancare patients. I went so far as to file a complaint with the state but to no avail. If we use anything other than our RHC NPI, the plans state that we our providers are not set up correctly with Medicaid. However, to set them up "correctly" they would need to be un-tied from our group, which would not be correct. We are working with our local health department to see if this is a service that they can provide.
5/18/2023 @ 8:38:00 AM
Post 3 of 7
Contributor: Amy Bennett, Borgess Lee Medical Group RHCs
We are provider based out of Michigan. Our providers send scripts to the pharmacy and the patient is to pick up the device there before the appt and we will place the device. We only bill Medicare and Medicaid for the insertion services.
5/19/2023 @ 9:34:00 AM
Post 4 of 7
Contributor: Shirley Gamble, Sterling Medical Center
Good morning Sherri and Amy and all of Kansas RHCs providing or wanting to
provide LARC (Long Acting Removable Contraception) services. The State and each KanCare MCO should be reimbursing for both the insertion, removal or insertion with removal at your RHC Medicaid AIR using POS 72 and your NPI associated with your RHC services. In addition, the devices, whether Nexplanon or one of the IUDs should be reimbursed using POS 11 and your NPI associated with your non RHC services. Kansas Medicaid does require RHCs to have two NPIs. The device charges have to be submitted on a different claim than the insertion, removal services. Your billing system may be able to split these out on two separate claims. As far as the provider setup with KanCare, the individual providers must each be credentialed and participating in network. This is different than the RHC being credentialed and participating. This would be the same for billing any other type of non RHC service including hospital inpatient services, Observation services, ER services, in site clinical lab or the technical components of radiology and EKG, etc. services. I hope this helps. I know it works as it is working for many RHCs in Kansas. Shirley * 5/31/2023 @ 2:41:00 PM
Post 5 of 7
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
Thank you Shirley for that information. What revenue code are you using for the IUD's and Nexplanon?
6/1/2023 @ 12:37:00 AM
Post 6 of 7
Contributor: Shirley Gamble, Sterling Medical Center
Since these products/devices are non RHC services they are billed on the 1500 claim form with CPT/HCPCS codes rather than revenue codes. J7296 for KYLEENA; J7298 MIRENA ; J7300 PARAGUARD; J7301 SKYLA; AND J7307 FOR THE NEXPLANON. SHIRLEY GAMBLE 920-960-3435 6/1/2023 @ 9:43:00 AM
Post 7 of 7
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
Thank you Shirley! I've forwarded to our billing department all the questions they wanted me to post and your answers. We were billing them correctly except for the NPI number. They didn't think our previous NPI numbers were still active since going to RHC. They have found those non-RHC NPI's, so hopefully we can get some claims paid.
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