esmoot
Guest
Say I bill a Medicaid patient for a code that I know my commercial insurers won't pay. Do I have to still bill the commercial payor and get the denial to show I'm billing equally?
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Wiki Equal Billing: If I bill Medicaid, do I have to bill commercial even if I know they won't pay the claim?
- Thread starter esmoot
- Start date
julieordway
Networker
Could you clarify with a little more information. What is the code and are you referring to the same patient? Is commercial primary and Medicaid the patients secondary?
esmoot
Guest
Yes; thank you. I'm talking about separate patients. I'm creating a billing policy, and am wondering in general, if we need to bill private/commercial insurance for all of the same services we bill Medicaid for. Is there a requirement that says that we need to bill all insurers equally for services. For example, if I'm billing G9012 which is case management with Oregon Medicaid, do I need to bill my contracted commercial insurers and get denials even though I know they won't cover the service. Or can I just bill Medicaid for G9012 and not bill the commercial insurers at all.
Medicaid is likely going to want to see the primary EOB before making payment.
You should confirm with Medicaid whether there's any exception for that specific case management service. Otherwise, I'd expect that you'll have to bill the primary before sending a secondary claim to Medicaid.
esmoot
Guest
Hi Susan, Thank you for your response. I'm not wondering about primary and secondary. I think I need to explain it better, here's an example. We have two patients. Say Patient "A" has Medicaid and we bill for example G9012, which they pay for, and we bill. If Patient "B" isn't on Medicaid and has, say Providence. Does Medicaid require us to bill Providence for G9012, even though we know they won't pay for it and will receive a denial?
julieordway
Networker
If that code is specific to Medicaid, then no, I wouldn't think that you have to bill the same to Providence.
amyjph
True Blue
No, you don't have to follow the same procedure from one plan to another if the plan (say Medicaid) requires a G code but the other plan doesn't accept or recognize it. That does not make sense. Medicaid can't dictate what code you bill to another plan. That would be like trying to bill Medicare for non-covered codes they tell us must be converted to the G codes. There may be compliance and other regulations when it comes to services offered or the clinic/practice in a broader sense when it comes to Medicaid. You do want to consider equitable billing policies for all patients. For example, you would want your fees to be consistent between all plans and for self-pay.
You also want to be careful about getting too detailed and specific in "billing" policies.
You also want to be careful about getting too detailed and specific in "billing" policies.
SDargaj
Networker
I would bill the primary first for the EOB. Medicaid will always be payer of last resort. If they see there is a commercial policy that was not billed before them, they will deny as covered by another payer. If you bill comm first, then they will have that primary EOB showing primary did not pay, but WAS billed........