# Out of State Medicaid Billing



## rubybluemonkey (Apr 2, 2014)

Hello,

We are having trouble finding regulation/terms on billing/not billing out of state Medicaid programs.

We are not located in a border town and therefore do not enroll in any bordering state Medicaid plans.  We are also ancillary providers and have no direct contact with the patients prior to service, so we don't know that we will have to bill an out of state plan. 

Many out of state plans are trying to tell us that we can bill their patients even though we are not enrolled providers, etc. 

Can we bill these patients? Our policy has been to do so but I can't find anything that says we can or cannot one way or another. 

Thanks.


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## MarcusM (Apr 2, 2014)

This is a conundrum. If you are not contracted with the patient's insurance plan, and the patient comes to you anyway, then you can bill them because you should have in your patient registration forms some type language that indicates the patient is ultimately responsible for all services. BUT, if the patient qualifies for Medicaid, this usually means they don't have much in the arena of financial resources to pay your bill.  I once enrolled one of my cardiologists in a New York Medicaid program to try to collect funds on a patient who was in Austin on vacation and had to have emergency cardiac treatments including surgery.  After it was all said and done and we got contracted, the reimbursements did not even cover the time I spend on getting contracted, much less the cardiologist's time and services.


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## winafred (Apr 2, 2014)

Marcus is correct, you can bill the member for services rendered if you are not contracted with their states medicaid plan.  I would recommend contacting their Medicaid Plan and seeing if an arrangement can be made for a one-time payment.  A lot of times, Medicaid plans will do that to protect the member from a financial hardship.


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## rubybluemonkey (Apr 2, 2014)

Marcus and Winafred, thank you, I have tried before to arrange for one time payment but the states will not budge and all have required full credentialing and enrollment. 

As Marcus stated this is not worth the time and effort for one $36.00 chest xray they are going to pay $6.00 on. 

I just want to make sure we are not breaking any rules by billing the patients and requesting them to seek reimbursement with their state plan.


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