Nebraska has specific guidelines and laws regarding medical billing, particularly for healthcare providers and facilities. Here are the key points:Nebraska Medicaid Billing Instructions

• CMS 1500 Claim Form: Nebraska Medicaid accepts the revised CMS 1500 claim form (version 02/12) for billing.
• Billing Codes: Nebraska Medicaid requires claims to be submitted using codes from the current version of ICD-10, CPT, and HCPCS Level II for the date the service was rendered.
• Timely Filing: Initial claims must be submitted within 12 months of the date of service. Resubmissions and adjustments must be submitted within 12 months of the date of the denial or 12 months from the date of service, whichever is later.

Nebraska Total Care Billing Guidelines

• Claim Forms: Nebraska Total Care only accepts the CMS-1500 (2/12) and CMS-1450 (UB-04) paper claim forms. All paper claim forms are required to be typed or printed and in the original red and white version.
• Billing Codes: Nebraska Total Care requires claims to be submitted using codes from the current version of ICD-10, ASA, DRG, CPT4, and HCPCS Level II for the date the service was rendered.
• Referring/Ordering Physician Requirements: When submitting professional service claims for PT/OT/ST, DME and Hearing Aid services on HCFA 1500 forms, the referring/ordering physician must be identified on the claim form (Box 17).

Billing Disputes and Denials

• Resolving Billing Disputes: Both healthcare providers and insurers are responsible for making and documenting timely, good faith efforts to resolve billing disputes. Written correspondence/email is more effective than telephone calls.
• Incorrect Coding: If a claim is returned due to incorrect coding, the insurer must pay/deny payment for the portion of the bill that is correctly coded, return the bill to the provider, and request additional information/documentation concerning the incorrect codes.

Patient Responsibility

• Billing Uninsured Patients: Several days after a patient is discharged from the hospital or receives outpatient services, they will receive a patient liability statement. Payment should be made upon receiving the statement, or the patient may contact Patient Financial Services to make payment arrangements.

These guidelines and laws aim to ensure that healthcare providers and facilities follow specific procedures for billing and claims submission, protecting patients from surprise medical bills and ensuring timely and accurate payment for services.