Medicare Advantage/Medicaid

[bumbleb]

Quick question:
We just received a referral for PT for a patient from a dr's office. Patient has a Medicare Advantage plan with a $50 specialist copay. She also has NC Medicaid - which pays $0 for physical therapy. How would that work?

I've only seen Medicaid with regular Medicare before. There, Medicare pays 80%, we write off the 20% , making sure the annual deductible has been met (or we have to write that off too).
In this instance, would she pay the $50, and the Advantage plan pays the rest, and it's like there's no secondary? Or would she expect Medicaid to cover her copay, and the Advantage plan would only pay the amount minus her copay??

I've never seen a Medicare Advantage plan and Medicaid together before. We just need to know before we schedule her for a visit. Thanks!
Bren

[DMK]

If P.T. is a NON COVERED benefit, they would pay whatever the primary dictates and it's AS IF there is no secondary.  If it's a COVERED benefit, you have to bill primary/secondary and you'll eat what not paid for.

[bumbleb]

I'm still a little confused. PT is covered by Medicare/Medicare Advantage. NC Medicaid does not cover PT if the pt is over 21.

So for this pt, I collect the $50 copay and submit to MA plan. They pay their rate minus $50. So there would be no need to bill Medicaid, correct? There would be no write-off.
Or does Medicaid cover her copay portion?  So I'd have to w/o the $50?

I normally don't see a lot of Medicaid (because they don't pay anything). Just as secondary to regular Medicare.
Thx

[Michele]

You need to check your state laws.  Many states have a law that says you cannot bill a Medicaid eligible patient.  That means you would have to write off the $50 copay.