Mr. Sheehan’s thoughts were presented in a recent webinar and reported by AIS Health. He said New York’s 18 NY CRR 504.9 regulates organizations known as third-party billers that submit Medicaid claims under contract with some New York providers.
Mr. Sheehan says the problem with the relationship between third-party billers and providers is frequently the lack of accountability. He says accountability should be present during each stage of the process: eligibility determination, claims submission and payment. Currently, the responsibility for inaccurate claims is often tossed back and forth between the two parties: Providers say the third-party billing entity failed to fact-check the material, and the third-party billing entity says it should not have to verify the accuracy of provided information.
The state regulation requires that all claims be reviewed by the provider, a requirement that some say is unrealistic. But nevertheless, providers should take responsibility for submitting accurate claims and implement a system that can detect inaccurate claims before submission.
Read the AIS Health report on claim submission.
Read more on claims:
–Ohio Workers’ Comp Bags Largest-Ever Restitution Payment: $830K From Jailed Anesthesiologist
–Medicare Carriers Properly Processing Surgery Center Claims With -PT Modifier
–Ohio Attorney General Wants State to Have Own False Claims Act
