Medicare/Medicaid

[dedwards]

Hello,
I bill for a community mental health facility which includes a day treatment program.  I have to bill Part A Medicare for the PHP level (H0035), however the other two levels:  Intensive day treatment level  (H2012) and Rehab day treatment level (H2017) are not covered under Medicare.  Since these levels are not recognized by Medicare, they are payable under Medicaid, and we've never had a problem getting them paid.  We are now beginning to bill Medicare Part A, so this question has now come up.  My question is if a patient has Medicare and Medicaid and is in either of the two levels not recognized by Medicare, do I still have to file Medicare first?  As of now, we are not a Medicare Part B provider.
Thank you for all your help!  We are about to order the Mental Health Book, and I'm looking forward to finding out much more about mental health billing.
Debbie

[Pay_My_Claims]

Yes you still have to file Medicare first. Medicaid will deny without seeing the EOB from Medicare.

[Michele]

Actually it varies from state to state.  In NY if it is a non covered service by Medicare then you do not have to bill them first.  You bill to Medicaid indicating that it is a non covered service.  Medicaid knows that Medicare doesn't cover it and they do not require an eob.  We used to bill exactly what you are talking about to NY Medicaid and the provider was not a Medicare provider.  We just had to send them with the correct codes to indicate a non Medicare covered expense.

Michele

[Pay_My_Claims]

well now I have learned something. I have always just billed the Medicare let it cross to medicaid and get paid. gotta go research now..........:-)