# Medicaid as primary or secondary- Can we charge the patient if they dont pay?



## Jm6161 (Aug 20, 2018)

if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can't trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.


----------



## mitchellde (Aug 21, 2018)

unless the patient has a form of Medicaid where they are required to pay a certain amount of the balance then no you cannot be collecting from the patient if Medicaid does not pay.  Spend -down Medicaid that some states still have is a type where the patient would owe a portion.  However the EOB would indicate this.  If it was a denial by Medicaid the no you cannot collect from the patient, you might can appeal the denial depending on the reason.
Remember those granted Medicaid are person that are financially as well as medically indigent, so in actuality you would be trying to collect from a patient that has not the funds to pay you.


----------



## wverret (Aug 22, 2018)

*Charging Clients in Medicaid*

I would check with your state Medicaid Agency.  In our state (Oregon), in general providers are not allowed to bill clients for covered services.  Our rules state that prior to the provider providing a non-covered service, they have to have the client sign a waiver notice or ABN prior to receiving services, then they can bill the client.  If the provider failed to have the client sign the ABN, then they can't bill the client.

Willie V.


----------



## Kpinckney24 (Aug 22, 2018)

In my experience if Medicaid is denying "Capitation MCO" the client may have a Managed Care plan that is liable for the charges. Check Epaces for a Medicaid Managed Care plan and bill to them. .


----------



## zcometa (Aug 22, 2018)

*Qmb*



Jm6161 said:


> if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can't trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.



If your practice is enrolled as a Medicare or a Medicare advantage plan provider then you are prohibited from balance billing Medicare deductibles, coinsurance, or copays from dually eligible (Medi-Medi or QMB) individuals.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNmattersArticles/downloads/SE1128.pdf

This though, doesn't mention if the patient has a Medicaid cost share that hey need to meet, only the cost sharing attributed to Medicare.


----------



## Jm6161 (Sep 5, 2018)

*To charge or not to charge a Medicaid Patient-- Thank you*

Thank you everyone for  your help on this. This for the state of Illinois Medicaid. So I need to researched it a little more. Anyone know how medicaid works in Illinois?


----------



## Rlopez2021 (Oct 5, 2022)

When a PT is Medicare and  Texas Medicaid and Medicare paid their portion, but Medicaid does not, and I receive the below notice, what does it mean? 
GLOSSARY: Adjustment, Group, Reason, MOA, and Remark codes
CO- Contractual obligations. The patient may not be billed for this amount
22This care may be covered by another payer per coordination of benefits.
N192 Patient is a Medicaid/Qualified Medicare Beneficiary.


----------



## dkissel (Oct 7, 2022)

Rlopez2021 said:


> When a PT is Medicare and  Texas Medicaid and Medicare paid their portion, but Medicaid does not, and I receive the below notice, what does it mean?
> GLOSSARY: Adjustment, Group, Reason, MOA, and Remark codes
> CO- Contractual obligations. The patient may not be billed for this amount
> 22This care may be covered by another payer per coordination of benefits.
> N192 Patient is a Medicaid/Qualified Medicare Beneficiary.


When a patient is a QMB (Qualified Medicare Beneficiary) you are not allowed to bill the patient. You must write off the balance. This is because Medicaid's fee schedule is usually much lower than Medicare and Medicaid will only pay up to their own fee for that procedure.


----------



## Rlopez2021 (Oct 7, 2022)

dkissel said:


> When a patient is a QMB (Qualified Medicare Beneficiary) you are not allowed to bill the patient. You must write off the balance. This is because Medicaid's fee schedule is usually much lower than Medicare and Medicaid will only pay up to their own fee for that procedure.


Thank you so much for clarifying this for me.


----------

