Part B Insider (Multispecialty) Coding Alert
Non-Par Medicaid? Bill the Patient
Question:We have recently had an influx of patients presenting with a commercial insurance card. Then the claim gets denied, and the patients respond that they decided not to continue with commercial insurance, but rather enrolled in Medicaid. However, we don’t accept Medicaid. As a non-participating practice, we will not get paid by Medicaid for seeing these patients, and therefore I would not have seen the patient if I’d known they were on Medicaid. Can we bill the patient in this situation?
Answer: Since you do not participate with Medicaid, you can charge the patients and if they do not pay, you can send the accounts to collections. In your bill, send a letter notifying the patient that they are responsible for the balance since you were not notified prior to the visit that the patient was on Medicaid (with which you do not participate).
If this is happening chronically, then you should start verifying patients’ insurance coverage before the first visit. If you are unable to verify the coverage, you might consider canceling the appointment or charging self-pay prices (which you would refund later if the insurer ends up being valid and paying you).
Part B Insider (Multispecialty) Coding Alert
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