Medical Billing Forum
Billing => Billing => : billingfromhome428 December 01, 2009, 05:08:34 PM
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Is there a way to get Medicaid to pay for the PT and other codes that Medicare doesn't cover?
Thanks!
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what state are you billing Medicaid (your post says medicare) as the secondary
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Duh! Oops! I am billing Indiana Medicaid.
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If they are services that Medicaid covers, but Medicare doesn't then Medicaid should pay. In NY there is a code we have to put on the claim to indicate it is a non covered Medicare service.
Michele
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What code do you use in NY?
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31 in the payor field. 3 means patient has Medicare but it's not a covered service. 1 means no commercial insurance.
Michele
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Each Medicaid is different. In Florida if you have Medicare and Medicaid, Medicaid doesnt pay when secondary to Medicare. What they pay is the patient's Medicare premiums.
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Each Medicaid is different. In Florida if you have Medicare and Medicaid, Medicaid doesnt pay when secondary to Medicare. What they pay is the patient's Medicare premiums.
We have that in NC, it is QMB medicaid, and it covers the part B premiums. This is the case when the client's income is too high for Medicaid, but low enough where they need assistance.
So you are saying there is no Medicaid plan in Florida that pays after Medicare???
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I was wondering the same thing. I was actually just going to begin researching this for myself. So is the patient responsible for the balance after Medicare - if Medicaid doesn't pay? Or does the Dr have to eat it!
Michele
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if it is like NC medicaid then the client has to pay the 20%. I looked up Florida medicaid and they have a lot of programs available, and I don't see one that states that if you have Medicare and medicaid, they won't pay after Medicare. I can't believe any state will offer medicaid for inpoverished people and make them pay the 20%. Every state that I know the medicaid paid if they had the one for disabled, or aged. When I billed Florida Medicaid (been at least 3 years) they paid the balance after medicare.
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The following is from Florida Statute 409.908 (13)(b)
Medicaid will pay no portion of Medicare deductibles and coinsurance when payment that Medicare has made for the service equals or exceeds what Medicaid would have paid if it had been the sole payor. It has never been the intent of the Legislature with regard to such services rendered by physicians that Medicaid be required to provide any payment for deductibles, coinsurance, or copayments for Medicare cost sharing, or any expenses incurred relating thereto, in excess of the payment amount provided for under the State Medicaid plan for such service.
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And from that it appears the patient cannot be billed?
Michele
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The following is from Florida Statute 409.908 (13)(b)
Medicaid will pay no portion of Medicare deductibles and coinsurance when payment that Medicare has made for the service equals or exceeds what Medicaid would have paid if it had been the sole payor. It has never been the intent of the Legislature with regard to such services rendered by physicians that Medicaid be required to provide any payment for deductibles, coinsurance, or copayments for Medicare cost sharing, or any expenses incurred relating thereto, in excess of the payment amount provided for under the State Medicaid plan for such service.
But that isn't what your reply states. I know that when medicaid is secondary to any policy it will not pay anything that EXCEEDS what it would pay as primary. Your reply implied that if a patient has Medicare & Medicaid in Florida...Medicaid only pays the premiums...therefore I questioned that. What you referenced was equal to NC's QMB Medicaid that pays a recipients Medicare Part B premiums.
Posted by: Steve Verno CMBS, CEMCS
Insert Quote
Each Medicaid is different. In Florida if you have Medicare and Medicaid, Medicaid doesnt pay when secondary to Medicare. What they pay is the patient's Medicare premiums.
your original post was very confusing