Induced abortion payment Guidelines

Induced Abortion

Medicaid payment for induced abortion is restricted to those that meet the following criteria:

• A physician has found, and so certifies in his/her own handwriting, that on the basis of his/her professional judgment, the life of the pregnant woman would be endangered if the fetus were carried to term.

• The certification statement must be attached to the claim form. The certification statement must contain the name and address of the patient. The diagnosis or medical condition which makes the pregnancy life endangering must be specified on the claim.

OR

• In the case of terminating a pregnancy due to rape or incest the following requirements must be met:

* *  The Medicaid recipient shall report the act of rape or incest to a law enforcement official unless the treating physician certifies in writing that in the physician’s professional opinion, the victim was too physically or psychologically incapacitated to report the rape or incest.

* *  The report of the act of rape or incest to a law enforcement official or the treating physician’s statement that the victim was too physically or psychologically incapacitated to report the rape or incest must be submitted to the Bureau of Health Services Financing along with the treating physician’s claim for reimbursement for performing an abortion.

* *  The Medicaid recipient shall certify that the pregnancy is the result of rape or incest and this certification shall be witnessed by the treating physician.

* *  The OPH Certification of Informed Consent-Abortion form shall be witnessed by the treating physician.

In order for Medicaid reimbursement to be made for an induced abortion, providers must attach a copy of the OPH Certification of Informed Consent-Abortion form to their claim form. Copies of this form can be requested from the Office of Public Health at (504) 568-5330. A blank copy of the form can be found on the following page.

Claims associated with an induced abortion, including those of the attending physician, hospital, assistant surgeon, and anesthesiologist must be accompanied by a copy of the attending physician's written statement of medical necessity.


Therefore, only hard-copy claims will be reviewed by the fiscal intermediary physician consultants for payment consideration.




Threatened, Incomplete, or Missed Abortion

Claims for threatened, incomplete, or missed abortion must include the patient history and complete documentation of treatment.

Supportive documentation that will substantiate payment may include one or more of the following, but is not limited to:

• Sonogram report showing no fetal heart tones

• History indicating passage of fetus at home, en route, or in the emergency room

• Pathology report showing degenerating products of conception

• Pelvic exam report describing stage of cervical dilation

No comments:

Medical Billing Popular Articles