Wiki Medicaid question

[ssmyers]

We are not enrolled as providers for Medicaid, but have recently been doing some inpatient consults. One of our physicians did an ERCP with stent placement today on an inpatient. There will be an outpatient ERCP scheduled for the removal. Is my physician required to schedule the removal since he did the placement, or can we legally refer the patient to the provider in town who is enrolled with Medicaid? I cannot find anything on the Medicaid website. What follow-up is required from us for a Medicaid patient from an emergent service? Can we bill the patient since we are not a provider?

 

[Skymom]

Each state is different. In Pennsylvania, par and non-par providers can't balance-bill Medicaid patients, nor can they bill the pt for any denied claim/service. In general here, non-par providers will never get reimbursement from Medicaid. One exception is in the case of an emergency, but auth must be obtained as soon as the pt has been stabilized, and even that is a long shot.

Search online for your state's Medicaid Billing Manual, and I'll hope it's a bit more generous than Pennsylvania's!