Wondering why Indiana Medicaid is denying your anesthesia claims performed during routine sterilization procedures? Most likely you’re missing a properly completed Consent for Sterilization form.
Voluntary informed consent is required by Indiana Medicaid before sterilization services will be paid for, and the consent form should be attached to all claims for voluntary sterilization and related services by all providers, including attending physicians and surgeons, assistant surgeons, anesthesiologists, inpatient and outpatient hospital facilities, and other providers of related services.
The consent form must be completed at least 30 days, but not more than 180 days, prior to the sterilization procedure, including when the sterilization is planned concurrently with a delivery, though Medicaid does allow for some exceptions for premature delivery. As well, the form cannot be completed retroactively. If the form is signed after the procedure is performed, Medicaid will deny all claims related to the procedure, and physicians and other providers must collect the balance due from the patient. This includes instances when a provider did not know a patient was covered by Indiana Medicaid. For this reason, Indiana Health Coverage Programs (IHCP) recommends that “providers use the Consent for Sterilization form for all patients in their practice.”
In addition to the timing of the form, federal and state regulations mandate that the form be filled out according to very specific guidelines. For instance, some answers must be handwritten, and if an error is made, a new form must be completed. As well, certain fields marked with an asterisk “must be completed with exactly the same wording and must match the procedure billed on the claim.” IHCP has a table of Instructions for the Consent for Sterilization Form (HHS-687) page 7 that indicates how to complete each question on the form.
Finally there’s the issue of getting access to an exact copy of the form, as the guidelines require. Typically, the consent form is completed only once by the surgeon performing the sterilization (or a staff member). Other providers must then request a copy of the form from the surgeon’s office in order to submit the claim. Failure to do so will result in a denied claim.
Tired of receiving Medicaid denials for anesthesia performed during sterilization services? Make sure you request and receive a property completed Consent for Sterilization form before every sterilization. Then, channel that form to your billing department or outsourced billing company so claims can be properly submitted.
Learn more about billing for sterilization and other family planning services by reviewing IHCPs Family Planning Services Provider Reference Module.
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