By Christine Williams, MSN, CNP, FAANP
OAAPN met with Ohio Medicaid Leadership and Director John McCarthy.
- OAAPN sought complete revision of the Medicaid billing rules with removal of all Medicaid billing restrictions, benefitting CNPs, CNMs and CNSs. CRNA billing is not addressed in these rules. The final rule has just been approved and only awaits approval by the Join Commission Rule Review (JCARR), which will occur in March or April.
- Medicaid revised APRN billing rules include: approval of reimbursement for APRN teaching practitioner services when supervising a resident, meaning that SNMs who supervise resident deliveries will be reimbursed for the delivery. Other APRN types may also seek reimbursement. The rule will be effective in early March
- Medicaid revised APRN billing riles also include: reimbursement for all APRN provided E&M services, including the most complex hospital visit and reimbursement for admissions, and reimbursement for all procedures. The previous list of approved procedures within the APRN scope of practice, which is not determined by Medicaid, are approved.
Medicaid Rule Changes currently in process:
- Rule on DME ordering: After negotiations, Medicaid agreed to change the rule on DME ordering, no longer requiring physician confirmation of APRN face to face visits. We have not received confirmation that this new rule has been published.
- APRN hospital admissions: OAAPN was notified that APRN Medicaid hospital admissions were not being reimbursed and that most hospitals were submitting the APRN admissions under a physician’s name to secure Medicaid reimbursement. APRN admitting legislation, HB 139, which passed in 2014, requires that Medicaid revise their hospital admitting rules to include APRNS. Outcome: Medicaid has confirmed they will revise the Medicaid admitting rules to recognize and reimburse for APRN admitting services.
- Urine Drug Screens: OAAPN is in discussion about the denial of APRN ordered urine drug screens. Medicaid rule review indicates there are conflicting Medicaid rules governing non-physician reimbursement for ordered urine drug screens with additional requirements that the physician be on site to bill.
Ongoing Member Services
- OAAPN answers member reimbursement questions. Members are encouraged to notify us if they have reimbursement problems.
- OAAPN represents member concerns to insurers as needed.
- Updated insurance Matrix – available to membership at all times.