Wiki Billing Medicaid for Non contracted physician

[GMMTimmons]

We have a physician who wants to drop his Medicaid/OHCA contract. He has asked how this will affect his patient's that have Medicaid as secondary.
Will he still be able to see them?
Can he bill Medicaid secondary without the contract?
Any advise or guidance is appreciated.

 

[SharonCollachi]

In my state, you cannot bill Medicaid if you are not contracted.

If a patient has Medicare primary and Medicaid secondary, and you cannot bill Medicaid, you MUST write off the patient portion of the bill. Many physicians offices mistakenly believe they can make the patient pay, but the Medicare frequently sends out information absolutely forbidding this practice.

So, he can continue to see them, but he cannot make them pay. Remember at the beginning of the year, if the patient's Medicare deductible has not been met, and you cannot bill Medicaid, you will get paid NOTHING for your services, and you CANNOT accept money from the patient or on the patient's behalf from someone else.

If a patient has another insurance primary and Medicaid secondary, then it depends on your state on whether or not you can collect from the patient. It is allowed in California.

If a patient has Medicaid only, then I've heard it depends on your state on whether you can collect from the patient. Every state I've looked up says the patient can choose to be a cash pay patient to see a provider of their choice, but some billers still insist it can't be done, and I haven't looked up every single state, so they may be right.

 

[GMMTimmons]

In my state, you cannot bill Medicaid if you are not contracted.

If a patient has Medicare primary and Medicaid secondary, and you cannot bill Medicaid, you MUST write off the patient portion of the bill. Many physicians offices mistakenly believe they can make the patient pay, but the Medicare frequently sends out information absolutely forbidding this practice.

So, he can continue to see them, but he cannot make them pay. Remember at the beginning of the year, if the patient's Medicare deductible has not been met, and you cannot bill Medicaid, you will get paid NOTHING for your services, and you CANNOT accept money from the patient or on the patient's behalf from someone else.

If a patient has another insurance primary and Medicaid secondary, then it depends on your state on whether or not you can collect from the patient. It is allowed in California.

If a patient has Medicaid only, then I've heard it depends on your state on whether you can collect from the patient. Every state I've looked up says the patient can choose to be a cash pay patient to see a provider of their choice, but some billers still insist it can't be done, and I haven't looked up every single state, so they may be right.

Thank you. I'm in Oklahoma but I am finding conflicting information. sigh...