Michigan's Medicaid program, known as the Michigan Department of Healthand Human Services (MDHHS), provides healthcare coverage to a diversepopulation and offers a wide range of services, including medical, dental,vision, mental health, and long-term care services. Here are some keydifferences and unique features of Michigan's Medicaid program that may impacthealthcare providers and billing procedures:

1. Managed Care: Michigan has a managed care system for most Medicaid beneficiaries. Managed care organizations (MCOs) are responsible for coordinating and providing covered services to enrollees. Providers must contract with MCOs to receive reimbursement for services rendered to Medicaid beneficiaries.
2. Medicaid Health Plans (MHPs): Michigan's Medicaid program includes Medicaid Health Plans (MHPs) that offer comprehensive managed care coverage to enrollees. Providers must enroll with MHPs to provide services to Medicaid beneficiaries enrolled in these plans.
3. Provider Enrollment and Credentialing: Providers must enroll with the  Michigan Medicaid program and meet certain qualifications to participate in the program. Credentialing requirements may vary depending on the type  of provider and the services rendered.
4. Distinct Billing Codes and Requirements: While Michigan Medicaid follows standardized code sets such as CPT, HCPCS, and ICD, it may have specific     billing codes and requirements for certain services or populations. Providers must be aware of these distinctions when submitting claims to Medicaid.
5. Telehealth Services: Michigan has expanded telehealth services, especially in response to the COVID-19 pandemic. Providers may need to adhere to specific billing procedures and requirements for telehealth services rendered to Medicaid beneficiaries.
6. Dual Eligible Beneficiaries: Michigan has a significant population of dual eligible beneficiaries who are enrolled in both Medicare and Medicaid. Billing     procedures for services provided to dual eligibles may differ from those for other Medicaid beneficiaries.
7. Care  Coordination and Case Management: Michigan emphasizes care coordination and case management for Medicaid enrollees with complex     healthcare needs. Providers participating in care coordination programs may need to follow specific billing procedures for these services.
8. Medicaid Health Information Exchange (HIE): Michigan has a statewide Medicaid Health Information Exchange (HIE) that allows providers to     securely share patient health information electronically. Providers participating in the HIE may need to follow specific billing procedures related to electronic health information exchange.
9. Provider Reimbursement Rates: Michigan sets reimbursement rates for covered services, which may differ from rates set by Medicare or private insurers. Providers should be aware of Michigan Medicaid's reimbursement rates when billing for services.
10. Continuous Program Changes: Michigan frequently updates its Medicaid program, including changes to eligibility criteria, covered services, and reimbursement policies. Providers should stay informed about these changes to ensure compliance with billing procedures.

These are some of the key differences and unique features of Michigan'sMedicaid program that may impact billing procedures for healthcare providers.Providers serving Medicaid beneficiaries in Michigan should familiarizethemselves with the specific billing requirements outlined by the MichiganDepartment of Health and Human Services (MDHHS) and managed care organizations.

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Michigan's Surprise Medical Billing Law

The Michigan Act typically applies to three types of treatment rendered by nonparticipating providers:

• Treatment of all emergency patients
• Services to non-emergency patients in participating hospitals where the patient does not have the opportunity to choose a participating provider (or the patient has not been provided with prior disclosure)
• Treatment of patients admitted to a hospital within 72 hours after receiving treatment in that hospital's emergency department

Michigan Medicaid Billing

• Providers cannot bill beneficiaries for services except in certain situations:
  • If a provider is not enrolled in Medicaid, they do not have to follow Medicaid guidelines about reimbursement, even if the beneficiary has Medicare as primary
  • If a Medicaid-only beneficiary understands that a provider is not accepting them as a Medicaid patient and asks to be private pay, the provider may charge the beneficiary its usual and customary charges for services rendered
• It is recommended that providers obtain the beneficiary's acknowledgement of payment responsibility in writing for the specific services to be provided

Michigan Workers' Compensation Billing

• The Health Care Services (HCS) Rules apply only to medical records in the possession of a health care provider relating to the specific work-related condition
• Professional review is required when medical costs per case exceed $20,000, for inpatient hospital care, or any case deemed appropriate by the carrier
• The carrier is responsible for a review program that determines the medical necessity and appropriateness of services
• Claims review is generally retrospective, as Michigan law does not mandate managed care, and is performed for purposes of reimbursement
• Providers licensed by the state of Michigan billing a carrier must accept the Maximum Allowable Payment (MAP) and shall not balance bill the worker

Billing Disputes

• If a clinic or hospital asks a patient to pay a bill that the patient believes should have been paid by their insurance company, the patient should call both the clinic/hospital and insurance company to see if there is still time for the claim to be processed
• If not, the patient should ask the clinic/hospital and insurance company about their obligation to pay the bill if the clinic/hospital's delay in filing caused the denial

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.