Coding, Billing and Reimbursement

Boy doctor exam

In 2005, reimbursement from Medicaid and CHP+ to private practices covered less than 2/3 of the actual cost for providing care. At that time, only twenty percent of pediatric practices accepted Medicaid or CHP+ patients. Eighty-five percent of Colorado pediatricians indicated they would accept more of these children if reimbursement was closer to the actual cost of providing care, and if the other supports provided by CCHAP were available.

In response, CCHAP has worked with HCPF and primary care practices to develop methods to enhance reimbursement for providers while providing a higher level of care for children by:

  1. Sharing more effective methods of billing and collecting from Medicaid.
  2. The best list of contacts to help solve claims processing problems.
  3. Problem-solving coding and claims issues.
  4. Facilitation of peer-to-peer connections.
  5. CCHAP newsletter articles including tips and tricks of coding.
  6. Helping practices understand how providing comprehensive preventive care services results in higher reimbursement.

Resources

CCHAP Vaccine Coding and Billing Guide 2016

Medicaid Billing Manuals

Medicaid Provider Fee Schedules

American Academy of Pediatrics 2016 Vaccine Coding Table

Contact us to learn more about CCHAP’s services.