Question about Medicare/Medicaid

[Steeni]

Sorry if I'm posting this in the wrong place, otherwise please direct me where to go...

I am a patient who has Medicare and Share Cost Medicaid...  My doctor's office will not accept the Medicaid but they want to tell me that my "balance is 0" anyways as they know I have financial hardship...  They've not flat out said that this is why, but it is implied.  I've read before that this should be documented in a patient's chart...  So, they are kind enough to waive this for me (it appears that they do this with a wlot of their patients as I can tell that most of the other patients have similar financial issues), but they won't accept the Medicaid ShareCost...  I don't think that they'll be willing to put anything in my chart as this would incriminate what they are doing with the other patients, I imagine...  Should I just say to myself, "Great! Nice doctor!" and accept this...  Can I be held liable in any way?  Also, they have not give me a bill (and I suspet that they won't).  If they show me the screen that says "0" balance I'll feel better about this...  Also, they are doing acupuncture, so I imagine that this won't end up being accepted by Medicaid anyways...

[PMRNC]

No, you have no liability here at all. Did they give you any kind of waiver for non covered services being billed out? What exactly is Share cost Medicaid? I've not heard of it, is it new? Like a supplemental benefit or managed care Medicaid?

[randy]

GOT HPSA BONUS PAYMENT RECD FROM MEDICARE FOR MY CLIENT

[Michele]

That's always nice!

[sierratam]

 I would say that Dr's office could end up in trouble if they were ever audited, because when it comes to a provider being contracted with a payor, medicare or commercial; the provider is obligated under that contract to collect whatever is determined to be patient responsibility. Otherwise they are not in compliance. This is not the patients' fault, though. But I'm am not positive how that would play out for the patient if the authorities got involved.
Also, regarding share of cost for medicaid (medi-cal in calif.) that is the amount of money a provider is to collect from the patient before they can bill medicaid, it's like a deductible. of course in this case the provider is not contracted with medicaid so they won't collect on that share of cost, but they are certainly supposed to collect from the patient medicare copay/deductible.

[Michele]

Yes, provider could be in trouble! 

[Claudelia]

I have a client who is a Medicare provider but not a Medi-Cal provider.  I called Medi-Cal and asked if we could charge the patient for copays and deductibles and they gave me a resounding "NO"!!  The copay issue is one thing, but the deductible just doesn't make sense to me.  I suppose if I called them again I'd get another answer???

[DMK]

If the service provided is a service covered by Medi-Cal, they can not collect deductible or co-pay.  The doctor KNOWINGLY accepted a Medi-Cal client (and they get to make that choice) that means they only get what's covered by Medicare and they have to eat the rest.  If they want the extra Medi-Cal money (and usually there is no extra, Medicare almost always pays more) then they must be a Medi-Cal provider and do all the paperwork.

If the service provided is NOT covered by Medi-Cal (Chiropractic for instance) then they MUST collect the deductibles and co-pays otherwise it's considered a kick-back.  I suppose you could have financial hardship papers on file, but the co-pay is relatively small and if you let them know up front, they should expect to pay.