Medical Billing Forum

Payments => Patient Billing => Topic started by: sassie42 on November 10, 2009, 03:44:35 PM

Title: medicare deductibles and coins
Post by: sassie42 on November 10, 2009, 03:44:35 PM
i work for a dme company in florida.   we are non par with all insurances. have #'s but no par.  big debate, my question is: can you bill patients for there medicare deductible and or coins if they have medicaid as secondary and medicaid denied pymnt of deductible or coins????  some people say yes others say no. but if all the claim went to pt deductible we wont see a dime if medicaid denies pymnt too.  we cant just eat the costs we need paid for services cant just write it off.
Title: Re: medicare deductibles and coins
Post by: Pay_My_Claims on November 11, 2009, 07:28:00 AM
I work DME as well, and it doesn't matter what type of services...you can only bill if medicaid denies and the denial states it is patient responsibility. Why is Medicaid denying?? This is where you need to start first. We have clients that have what they call QMB medicaid in NC. This only covers the Medicare Pt B premiums. This means the client does not have full medicaid benefits therefore the balance after Medicare and the medicaid denial makes the patient 100% responsible for the balance. Please feel free to email me if you need to.

Title: Re: medicare deductibles and coins
Post by: PMRNC on November 11, 2009, 12:53:01 PM
Wouldn't you need to have an ABN on file?
Title: Re: medicare deductibles and coins
Post by: Pay_My_Claims on November 11, 2009, 01:23:40 PM
question is will that ABN work when you have a 2ndary insurance???  I think his issue is medicare is paying and his 20% is being denied by caid. There are items not allowed by caid in NC and what we do is yes have them  pay up front and file non-assigned. They really need to show why caid is denying before it can be resolved.
Title: Re: medicare deductibles and coins
Post by: PMRNC on November 11, 2009, 06:32:58 PM
Doesn't matter about coverage so long as Medicare is PRIME, the ABN is for Medicare and if the balance due is the deductible and coinsurance from Medicare the ABN should be fine.
Title: Re: medicare deductibles and coins
Post by: Pay_My_Claims on November 12, 2009, 07:11:50 AM
yeah, but that medicaid secondary bothers the hell out of me with that ABN, plus you just can't have a blanket ABN. You have to have a reason for them to sign IE, non coverage, or the cost is above the allowables, or they don't qualify for an item. You just can't have them sign the ABN because their secondary insurance won't pick up the 20%. I personally wouldn't use an ABN in this case.