There really needs to be a discussion between the groups (DHSS, LPHAs, Medicaid and FS) about this. Years ago we were able to bill for WIc services and it was a very easy billing process. I actually called about the process to bill when I started here in 2007. I was told then we did not have to have an RN doing the WIC visits to bill Medicaid for them. The only rule was that we could not bill for services unless we could show that we did not have enough money from WIC to cover WIC. As we are all learning more about billing/coding (because we have been forced to for revenue) and review the provider manual we realize we cannot bill the 99211 unless an RN is seeing the clients. There have also been many questions asked about how to verify new vs established client since most of us dont’ have MD’s in the office but are using standing orders in which the MD who wrote the orders will likely never see our patients. There is so much confusion around this and the only assurance I can get it “well everyone bills WIC and they have always allowed it so they can’t do much to you.” Ummmm, no thanks. I need something more in writing or within a policy than that.
Our WIC caseload is down and the WIC budget situation is not good. If we ever needed the revenue for these visits from Medicaid it is now. Add to the revenue loss the confusion about signing releases in WIC, audits, etc and all of this will take more time=more money.
I have been asking for someone to create a task force or group to address these issues for the last two years but nothing gets done. It is the lpha’s who are suffering. We are losing revenue and we need guidance. We are left either unfunded or in a situation where we can get into legal trouble for billing incorrectly. It baffles me that we are still all confused about this and cannot get a solid answer from anyone. There are simple fixes to all of these issues if we could just get a group of decision makers from the agencies above to sit down and listen to the LPHA’s. I know an SBAR has been created to address the issues on HEDIS, hopefully that conversation will expand and we can get something done.