Billing Rules of Genetic Counseling in Oklahoma

Advanced technology and scientific knowledge have led to the ability of health care providers to screen couples for genetic issues that may cause deformities, birth defects or medical conditions should they have children. Genetic counseling has become not only a service commonly covered by health insurance plans, but also something that many insurers encourage as a means to head off potential problems. When Oklahomans carrying private health insurance or who pay out of pocket receive genetic counseling services, providers have no specific billing restrictions under state law. However, services covered by state programs have billing rules with which providers should comply.

Copayments

• Genetic counselors seeing patients covered by Oklahoma's Medicaid program, SoonerCare, should collect copayments as specified by patients' coverage and deduct this amount from the total billed to SoonerCare. Under SoonerCare provider contracts, genetic counselors cannot refuse services to patients for lack of a copayment -- although the patient remains liable for the missing payment.

Billing Codes

• Patients on Oklahoma public assistance health plans are allowed to see genetic counselors as part of their family planning coverage. According to the U.S. Department of Health and Human Services, providers must bill the state on an "encounter" basis and should bill with a UB-92 form using revenue code OP514 and procedure code W4853 for initial visits, and W4854 for follow-up visits.

Direct Billing

• The Oklahoma Health Care Authority (OHCA) forbids using third-party billers who may also be profiting parties, such as factoring companies. When a provider sends a bill, the OHCA expects it to be clear, accurate and preferably billed electronically. Providers must give the OHCA bank account information for direct deposit of payments, which are typically made 45 days after receipt of accurate and correct billing.