Due to concerns with the Coronavirus pandemic, the Alabama Medicaid Agency (Medicaid) is making temporary changes to allow reimbursement of telephonic postpartum visits provided during dates of service March 16, 2020 through April 16, 2020.These actions will be effective for one month, expiring on dates of service April 16, 2020. Alabama Medicaid will be reevaluated for a continuance as needed.Clarification for billing is described below:
·DHCPs should bill established-patient evaluation and management codes 99211, 99212, and 99213 for a postpartum visit. The 14-office visit limit will apply when billing these codes. For Medicaid to ensure proper reporting, it is necessary to file the claim with place of service ‘02’ (telemedicine) and a modifier ‘CR’ for catastrophic/disaster to assist with claims tracking. Although Medicaid will allow a telephonic postpartum visit, a face-to-face visit must be performed when the COVID-19 emergency has ended. The telephonic visit must include, but not limited to the following details that will be documented in the medical record:
oDemographic data (patient name, Medicaid ID, age, address, etc.)
oGeneral health assessment (e.g. bleeding, healing of episiotomy site or
cesarean site, s/s of infection, pain, etc.)
oHas the postpartum face-to-face visit been scheduled?
oFamily planning assessment (birth control type/birth spacing)
oEducational discussions (car seat safety, infant safety, family planning)
oReview medications (do any need to be called into the pharmacy?)
·ACHN Bonus Incentive: There will be no change to the ACHN Bonus Incentive payment. This is reimbursable only
when a face-to-face postpartum visit occurs within 21-56 days of the delivery.
·Face-to-face postpartum visit: The postpartum visit is usually billed to Medicaid as part of the global fee. Medicaid
will not end a SOBRA pregnant woman’s Medicaid during the emergency declaration for this COVID-19 pandemic;
therefore, schedule the recipient’s face-to-face visit as soon as possible to prevent unnecessary denials.
·The face-to-face postpartum visits (usually included in the global), ACHN Bonus, and telephonic visits are all separately reimbursable during the pandemic. To receive reimbursement for the Bonus Payment, the service must be provided within 21-56 days of delivery as explained above.
NOTE: Payments for telephonic visits for postpartum care are subject to recoupment if the face-to-face postpartum visit is not performed at a later date.
During the COVID-19 emergency, it is important to file claims as quickly as possible to ensure payment from Medicaid is made to Medicaid providers close to date of service. The Centers for Medicare and Medicaid Services has increased the federal matching percentage for the emergency timeframe, but states can only receive the increased match on claims that are paid during the emergency.