Medical Billing Forum

Billing => Billing => Topic started by: swamy on June 03, 2009, 01:37:23 AM

Title: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: swamy on June 03, 2009, 01:37:23 AM
We Have primary as Medicare and secondary ins as Medicaid, Medicare paid and secondary open amount is Less then 20% of Medicare allowed amount, do we get payment from Medicaid or do we have to write off the balance?
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Michele on June 03, 2009, 06:34:30 AM
Medicaid should make payment.  Any balance after Medicaid makes payment would be written off.

Michele
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: swamy on June 04, 2009, 04:48:36 AM
Thank you very much !!!

I have one more question about ERA remits, In ERA remit file, if we are not receiving SVC segment, how we will be handling in software and where we can get the DOS for that payment.

once again thank you for your reply, and please suggest me if i am posting the query in the wrong section.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Michele on June 05, 2009, 06:00:00 AM
I'm not sure if I understand what you are saying.  The ERA should have all the same info as a paper remit.

Michele
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: PMBS on June 12, 2009, 10:10:18 AM
To my understanding Medicaid is a payor of last resort so if Medicare as primary paid more than what Medicaid would pay they do not pay anything.  I am Florida so I don't know it works different if you are in a different state.  We usually write of the balance if a patient has Medicaid.  The only thing Medicaid pays for is the deductible.  I called Medicaid on this many times and was told that because of the balance budget act we can not bill the patient.

However, there are some Medicaid plans that only pay for the patient's Medicare Premium and in that case we can bill the patient.

I hope this helps.

MR
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: swamy on June 16, 2009, 05:57:56 AM
Yes MR, we are doing the same as you said, once Primary pays, and Medicaid is secondary, we write off the balances, except incase of primary Deductables.

But recently we got payment from Medicaid after we did write off,

again we did debit adjustment and posted the payments, that is why this question proved me.

thank you for your reply.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Michele on June 17, 2009, 05:32:44 AM
We bill Medicaid when secondary to Medicare all the time.  In NY they pay 20% of the 20% balance after Medicare as well as the deductible.  I have also experienced similar in other states. 

Michele
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Pay_My_Claims on June 17, 2009, 06:33:30 AM
Yes MR, we are doing the same as you said, once Primary pays, and Medicaid is secondary, we write off the balances, except incase of primary Deductables.

But recently we got payment from Medicaid after we did write off,

again we did debit adjustment and posted the payments, that is why this question proved me.

thank you for your reply.

why are you w/o the balances when caid is 2ndary??
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: PMRNC on June 17, 2009, 09:02:13 AM
Quote
why are you w/o the balances when caid is 2ndary??

Because there shouldn't be a balance generally after Medicaid
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Pay_My_Claims on June 17, 2009, 12:07:25 PM
Maybe I am misreading because the way I took this was they were adjusting off BEFORE medicaid paid.

""Yes MR, we are doing the same as you said, once Primary pays, and Medicaid is secondary, we write off the balances, except incase of primary Deductables.

But recently we got payment from Medicaid after we did write off,

again we did debit adjustment and posted the payments, that is why this question proved me.

thank you for your reply.""
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: lhough on June 17, 2009, 09:33:53 PM
I too took it to mean that they were writing off if Medicaid was secondary prior to submitting and Medicaid paying.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: PMRNC on June 18, 2009, 07:18:50 AM
I read and was speaking of this:
Quote
Medicaid should make payment.  Any balance after Medicaid makes payment would be written off.

I've had many claims were Medicaid paid after Medicare, most notably my mental health patients in nursing homes. Granted the Medicaid Payments were pretty measley but they still paid secondary to Medicare.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Pay_My_Claims on June 18, 2009, 08:09:14 AM
Yes, that statement is fine, its the one that I copied that's questionable. Even the post subject says "can we bill medicaid when it is secondary" and since they are doing adjustments after medicaid pays, it says to me that after the primary pays they were w/o the balances "except for the deductibles" and letting it go. Now once medicaid paid (probably from a crossover) they would have to go back in and do adjustments. Why would you do adjustments if you haven't w/o anything??
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: PMRNC on June 18, 2009, 08:52:06 AM
Right I see what you are saying, what we should have said was.. don't write off or adjust anything off after primary pmt and adjustment UNTIL secondary payor pays. If they continue that practice they will just have to go and make adjustments to adjust down any secondary pmts/adjustments anyway. Messy file.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Pay_My_Claims on June 18, 2009, 10:01:32 AM
I drink sometimes so I thought I was delusional !!!  ;D
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: lhough on June 18, 2009, 02:09:39 PM
to me if they continue to adjust off prior to Medicaid paying and then once they pay they have to adjust again seems to me that they are just making a heck of a lot of unnecessary work for themselves and makes the file a mess.  I would hate to have to aduit their files, what a mess.
Title: Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
Post by: Pay_My_Claims on June 18, 2009, 03:28:45 PM
No, I would love to take over that account because its a very simple mistake that I can show a provider to get his business. Once I get that account, I know how to post it correctly!!!