Mississippi Medical Billing Guidelines

• ICD-10-CM Codes: Mississippi requires the use of ICD-10-CM codes for diagnoses, including bills for PPD evaluations.
• CPT Codes: CPT codes are used for procedures, and they must be unbundled.
• HCPCS Codes: HCPCS codes are used for supplies, equipment, and drugs. Q3014 is an allowable service for FQHC/CCBHC and CCBHC.

Mississippi Medical Billing Laws

• Timely Billing and Reimbursement:
  • Health Care Provider Responsibilities:
    • Submit initial bill within 90 days after the date of service
    • Appeal to DIR within 60 days from EOB/EOR
    • Only reason for later billing: if claim acceptance is delayed beyond 12 months due to claim’s litigation
    • Use current UB-04/CMS 1500 Forms
  • Insurer/TPA Responsibilities:
    • Pay or deny bill within 45 calendar days of receipt

Incorrect Coding

• Insurer Response:
  • Pay/deny payment for portion of bill correctly coded
  • Return bill to health care provider, request additional information/documentation concerning incorrect codes
  • Approve or deny payment within 20 days after receipt by the insurer of resubmitted bill with additional information/documentation

Resolving Billing Disputes

• Healthcare Provider and Insurer Responsibilities:
  • Both parties are responsible for making and documenting timely, good faith efforts to resolve billing disputes
  • Written correspondence/email is more effective than telephone calls
  • Document all efforts - date, time, contact person’s name

Common Mistakes

• Failure to bill using Mississippi Specific Codes
• Inappropriate billing of Observation Care
• Using revenue codes
• Failure to bill using CPT codes
• Incorrect coding
• No/minimal attempts to resolve billing issue independently

Telehealth Services

• Mississippi Medicaid Coverage: Telehealth services are covered by Mississippi Medicaid when deemed medically necessary.
• Eligible Sites: Facilities eligible for encounter reimbursement (e.g., Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee.
• Originating Site: Use procedure code Q3014. Originating site Telehealth services are not reimbursable as encounters.

Additional Guidelines

• Prior Authorization: Obtain written prior authorization when appropriate.
• Appeal Rights: Give/follow appropriate appeal rights on EOBs and denial letters.
• Contractual Agreements: Be aware of contractual agreements, changes, and discounts.

Examples of Codes Used in Mississippi

• ICD-10-CM Code for Hypertension: I10.9 (Essential hypertension)
• ICD-10-CM Code for Diabetes: E11.9 (Type 2 diabetes mellitus without complications)
• ICD-10-CM Code for Heart Failure: I42.0 (Acute heart failure)

Examples of Codes Used in Medical Billing in Mississippi

• CPT Code for ECG: 93000 (Electrocardiogram, routine ECG with 12 leads)
• CPT Code for Mammography: 77055 (Mammography, screening and diagnostic, 2 views)
• CPT Code for Colonoscopy: 45378 (Colonoscopy, flexible, with biopsy)

Examples of Codes Used in Medical Coding in Mississippi

• ICD-10-CM Code for Pneumonia: J18.9 (Pneumonia, unspecified)
• ICD-10-CM Code for Chronic Obstructive Pulmonary Disease (COPD): J44.9 (Chronic obstructive pulmonary disease, unspecified)
• ICD-10-CM Code for Chronic Kidney Disease: N18.9 (Chronic kidney disease, unspecified)

These codes are used to accurately document and bill medical services in Mississippi, ensuring timely and appropriate reimbursement for healthcare providers.