if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can't trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.
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Wiki Medicaid as primary or secondary- Can we charge the patient if they dont pay?
- Thread starter Jm6161
- Start date
mitchellde
True Blue
unless the patient has a form of Medicaid where they are required to pay a certain amount of the balance then no you cannot be collecting from the patient if Medicaid does not pay. Spend -down Medicaid that some states still have is a type where the patient would owe a portion. However the EOB would indicate this. If it was a denial by Medicaid the no you cannot collect from the patient, you might can appeal the denial depending on the reason.
Remember those granted Medicaid are person that are financially as well as medically indigent, so in actuality you would be trying to collect from a patient that has not the funds to pay you.
Remember those granted Medicaid are person that are financially as well as medically indigent, so in actuality you would be trying to collect from a patient that has not the funds to pay you.
Charging Clients in Medicaid
I would check with your state Medicaid Agency. In our state (Oregon), in general providers are not allowed to bill clients for covered services. Our rules state that prior to the provider providing a non-covered service, they have to have the client sign a waiver notice or ABN prior to receiving services, then they can bill the client. If the provider failed to have the client sign the ABN, then they can't bill the client.
Willie V.
I would check with your state Medicaid Agency. In our state (Oregon), in general providers are not allowed to bill clients for covered services. Our rules state that prior to the provider providing a non-covered service, they have to have the client sign a waiver notice or ABN prior to receiving services, then they can bill the client. If the provider failed to have the client sign the ABN, then they can't bill the client.
Willie V.
Kpinckney24
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In my experience if Medicaid is denying "Capitation MCO" the client may have a Managed Care plan that is liable for the charges. Check Epaces for a Medicaid Managed Care plan and bill to them. .
zcometa
Networker
Qmb
If your practice is enrolled as a Medicare or a Medicare advantage plan provider then you are prohibited from balance billing Medicare deductibles, coinsurance, or copays from dually eligible (Medi-Medi or QMB) individuals.
https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNmattersArticles/downloads/SE1128.pdf
This though, doesn't mention if the patient has a Medicaid cost share that hey need to meet, only the cost sharing attributed to Medicare.
If your practice is enrolled as a Medicare or a Medicare advantage plan provider then you are prohibited from balance billing Medicare deductibles, coinsurance, or copays from dually eligible (Medi-Medi or QMB) individuals.
https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNmattersArticles/downloads/SE1128.pdf
This though, doesn't mention if the patient has a Medicaid cost share that hey need to meet, only the cost sharing attributed to Medicare.
Rlopez2021
Guest
When a PT is Medicare and Texas Medicaid and Medicare paid their portion, but Medicaid does not, and I receive the below notice, what does it mean?
GLOSSARY: Adjustment, Group, Reason, MOA, and Remark codes
CO- Contractual obligations. The patient may not be billed for this amount
22This care may be covered by another payer per coordination of benefits.
N192 Patient is a Medicaid/Qualified Medicare Beneficiary.
GLOSSARY: Adjustment, Group, Reason, MOA, and Remark codes
CO- Contractual obligations. The patient may not be billed for this amount
22This care may be covered by another payer per coordination of benefits.
N192 Patient is a Medicaid/Qualified Medicare Beneficiary.
When a patient is a QMB (Qualified Medicare Beneficiary) you are not allowed to bill the patient. You must write off the balance. This is because Medicaid's fee schedule is usually much lower than Medicare and Medicaid will only pay up to their own fee for that procedure.
Rlopez2021
Guest
Thank you so much for clarifying this for me.