Wiki Need help with confusing Medicare

[mitzfritz215]

Just a few questions -

When Medicare posts that the patient has a deductible and the patient has Medicaid but they don't pay does the patient still owe the deductible? Sometimes I see Medicaid does pay for part of the deductible (but I think it's in error on their part). I have seen when Mediaid has come back some time later and take the payment out of the system.

Do I write off the balance due if Medicaid posts "Denial"? I usually don't write those off due to not being eligibile. Should I? I see in the system that another employee before me wrote them off when it read "Denial". I usually write off the posts that read "Did not pay on the Charge".

Last one - Does anyone know why Medicare would not pay on the charge (when the patient is still on Medicare) and take the full amount and adjust it off? I see this all the time and I'm not sure why they do it.

Thanks for your help.

 

[Cyndi113]

The answer to the first, the Medicare payment is usually more than Medicaid allows. As to the deductible, I wouldn't write off the deductible. I would question why Medicaid isn't paying. If you have a contract with Medicaid and they say patient is not respnosible do not bill the patient. Find out why they didn't pay and why the claim was denied. Appeal if necessary.

I would also question why Medicare is not paying a charge. Sometimes, its their error. Sometimes its for a simple modifier or dx code. You need to question why you are being asked to adj a claim off before you write it off.