Wiki Billing a Medicaid HMO

[chouston22]

If I see a patient without verifying their HMO can they be billed if I do not participate

 

[sls314]

If I see a patient without verifying their HMO can they be billed if I do not participate

There are extremely few circumstances where a Medicaid patient can be billed out of pocket. I would chalk the visit up to a registration error and tighten up my benefit verification procedures.

 

[chouston22]

There are extremely few circumstances where a Medicaid patient can be billed out of pocket. I would chalk the visit up to a registration error and tighten up my benefit verification procedures.

What if the baby is seen just a few days old and has not yet enrolled into the HMO and parent chooses a different HMO that we do not PAR with. Patient has already been seen.

 

[mortonj3191]

What if the baby is seen just a few days old and has not yet enrolled into the HMO and parent chooses a different HMO that we do not PAR with. Patient has already been seen.

From previous experience with Virginia Managed Care Plans they would pay out of network benefits for the first 30 days. That would give them time to change plans to a plan you are in network with. One would hope that other states would do the same & at least pay for the first 30 days until the patient can change plans again!