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Detailed guide on New Hampshire
New Hampshire has specific guidelines and laws regarding medical billing, particularly for healthcare providers and facilities. Here are the key points:New Hampshire Balance Billing Law
- Prohibition on Balance Billing: New Hampshire law prohibits anesthesiologists, radiologists, pathologists, and emergency medicine providers from billing commercially insured patients who are treated at an in-network hospital or ambulatory surgery center for more than the in-network cost-sharing amount.
New Hampshire Healthy Families Billing Manual
- Claims Filing Instructions: New Hampshire Healthy Families, a managed care organization, requires providers to adhere to specific billing requirements to ensure timely processing of claims and avoid unnecessary rejections or denials.
- Required Information: Providers must include the following information on claims:
- Patient name and ID number
- Date of service
- Total charges
- Provider name
- Present on Admission (POA) indicator for inpatient facilities
- Medicaid ID numbers for out-of-network providers
- Medicare coverage or other third-party coverage information
- Required Consent Forms
- Claim Submission: Claims must be submitted within 180 days of the date of service for original claims. Corrected claims must be submitted within 365 days of the date of service.
- Reconsideration and Claim Disputes: Requests for reconsideration and claim disputes must be received within 180 days from the original date of notification. Claims received outside of this timeframe will be denied for untimely submission.
- Electronic Data Interchange (EDI): New Hampshire Healthy Families supports electronic claim submission, which reduces administrative costs and improves transaction times.
New Hampshire Insurance Department (NHID) and Federal No Surprises Act (NSA)
- NSA Provisions: The NSA expands the prohibition against balance billing to all emergency care, out-of-network providers at in-network facilities, and air ambulatory providers. This provides greater protections against balance billing than New Hampshire's current law.
- Enforcement: The NHID will enforce the NSA provisions for emergency and pathology, radiology, and anesthesiology services in non-emergency cases. In all other cases, the federal Centers for Medicare & Medicaid Services (CMS) will enforce the NSA provisions.
Additional Guidelines
- Verification Procedures: New Hampshire Healthy Families verifies claims by checking for completeness and accuracy of required fields on the claim form, including the POA indicator for inpatient facilities.
- Provider Communication: Providers can contact New Hampshire Healthy Families for claim status, payment amounts, or denial reasons. They can also submit corrected claims or request reconsideration.
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.
Here are some examples of medical coding codes used in New Hampshire:ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)
- ICD-10-CM Codes for Diagnosis:
- 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)
CPT (Current Procedural Terminology)
- CPT Codes for Procedures:
- 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)
HCPCS (Healthcare Common Procedure Coding System)
- HCPCS Codes for Supplies and Equipment:
- HCPCS Code for Oxygen Therapy: A4600 (Oxygen, liquid, for inhalation therapy)
- HCPCS Code for Wheelchair: E1161 (Wheelchair, manual, with seat and back support)
- HCPCS Code for Insulin Pump: A6234 (Insulin pump, external, with continuous glucose monitoring system)
These codes are used to accurately document and bill medical services in New Hampshire, ensuring timely and appropriate reimbursement for healthcare providers.
New Hampshire follows the standard medical coding guidelines and uses the same coding systems as the rest of the United States. The main coding systems used in New Hampshire are:
- ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification): Used for diagnosis coding
- CPT (Current Procedural Terminology): Used for procedure coding
- HCPCS (Healthcare Common Procedure Coding System): Used for supplies, equipment, and drugs
New Hampshire Healthy Families, a Medicaid managed care organization, provides specific billing guidelines for providers to ensure accurate and timely claims processing. Some key points regarding coding:
- Providers must use the appropriate ICD-10-CM, CPT, and HCPCS codes on claims submitted to New Hampshire Healthy Families
- Inpatient facilities are required to submit a Present on Admission (POA) indicator on all claims
- Providers must obtain prior authorization for certain services and include the authorization number on the claim
To gain the necessary skills for medical coding, there are several training options in New Hampshire:
- AAPC-approved classroom training programs at locations throughout the state
- Online ICD-10 medical coding courses through the University of New Hampshire
- A Medical Coding certificate program at NHTI (New Hampshire Technical Institute)
These programs teach students how to accurately assign ICD-10-CM, CPT, and HCPCS codes based on medical documentation, preparing them for a career as a certified medical coder in New Hampshire.