Wiki 2ndary insurance billing /timely filing

[Bluteam]

I have a question when it comes to billing a 2dary medicaid / or commercial insurance. I have always been told that in order to do a write off you must have a remit advice, voucher, check, Explanation of benefits telling you do to so. I was told by my instructors and other insurance and an accountant that you must bill the other insurance on file even if its past filing limits prior to doing a write off. I'm being told my current employer not to do so. Please advise with any information you may have . or any references you have to this effect.

 

[beckiw]

I'm out of network with straight Medicaid. With QMB patients, I can't bill Medicaid, but I must write it off. So I never have an EOB, but I have documentation of the patient being QMB. But no, if you know the primary has already paid you than Medicaid allows, just write off and move on.

 

[codingforthesol]

Honestly, I would send a claim to the secondary insurance even if it is passed timely filing. Patients present their insurances to you which means that you are filing claims for them on their behalf, so it is best that you file and receive a denied EOB stating that it is passed timely filing or not covered due to being out of network. It's good to leave paper trail than none in case auditors ask in the future (you'll never know). My practice does a courtesy for patients who have Medicaid as secondary to write off whatever is remaining after primary, but I was told in the past that you technically can bill Medicaid patients as long as they sign ABN form (if Medicare is primary).

 

[SharonCollachi]

, but I was told in the past that you technically can bill Medicaid patients as long as they sign ABN form (if Medicare is primary).

This is incorrect AND is prohibited by the federal government. You cannot collect ANYTHING from a QMB patient (Medicare-Medicaid) unless they happen to have a Share of Cost.

The "Balance Billing" Q & A referenced above answers the question, "May a provider bill a QMB for either the balance of the Medicare rate or the provider's customary charges for Part A or B services?" with a straightforward, "No." The guidance continuesroviders who bill QMBs for amounts above the Medicare and Medicaid payments (even when Medicaid pays nothing) are subject to sanctions. Providers may not accept QMB patients as "private pay" in order to bill the patient directly, and providers must accept Medicare assignment for all Medicaid patients, including QMBs.

 

[codingforthesol]

This is incorrect AND is prohibited by the federal government. You cannot collect ANYTHING from a QMB patient (Medicare-Medicaid) unless they happen to have a Share of Cost.

The "Balance Billing" Q & A referenced above answers the question, "May a provider bill a QMB for either the balance of the Medicare rate or the provider's customary charges for Part A or B services?" with a straightforward, "No." The guidance continuesroviders who bill QMBs for amounts above the Medicare and Medicaid payments (even when Medicaid pays nothing) are subject to sanctions. Providers may not accept QMB patients as "private pay" in order to bill the patient directly, and providers must accept Medicare assignment for all Medicaid patients, including QMBs.

Got it, that's IF they are QMB because if I'm not mistaken, I believe that part was updated in 2017. Thanks for the information!

 

[suki_26]

Medicaid is not going to pay on most things... We have created a list of the codes we bill that Medicaid will pay the coinsurance on and the ones they wont. If a code is on the no pay list we dont even bother sending we just adjust it.

It takes so long to get the EOB/denial back from Medicaid and that is just leaving those claims on our AR longer than needed.

Other insurance companies absolutely get the denial for a paper trail but Medicaid we don't bother.