Medical Billing Forum

General Category => General Questions => Topic started by: Anne on July 12, 2010, 12:20:59 PM

Title: medicaid billing
Post by: Anne on July 12, 2010, 12:20:59 PM
If a patient has Medicaid as a secondary insurance, but we were unaware of this until after several months of treating him, can we bill patient?  Patient is not on med. due to financial need.  (they are on a medicaid program for children w/ special needs)  (TX medicaid)
Title: Re: medicaid billing
Post by: aksharhealth on July 12, 2010, 02:18:11 PM
Yes you can bill patient because pt did not gave you insurance info at time of service or within time frame. If pt gave you Medicaid info within time frame then bill to Medicaid.
Title: Re: medicaid billing
Post by: Michele on July 13, 2010, 07:22:36 AM
I would check your state laws first though.  Some states have laws that you cannot bill patient's that are eligible for Medicaid, it doesn't differentiate between financial need or other.
Title: Re: medicaid billing
Post by: mbspecialsit on July 13, 2010, 12:32:37 PM
I'm in AZ, and we cannot bill patient if they had Medicaid on date of service. Regardless if they
advised us they had Medicaid or not. But we have the same problem in our office. I always check
on our Medicaid website just to make sure.
Title: Re: medicaid billing
Post by: blhoffman on July 13, 2010, 01:43:41 PM
Hi Anne,

I would bill the Medicaid plan. When you receive the timely filing denial,  I would write the appeal to the 95 day exception. Outline the fact, services were rendered in good faith, the patient/parent did not disclose he/she had secondary insurance. Give dates of service, treatment received and when exactly you were made aware of this insurance coverage. I would not bill the patient unless Medicaid denied as patient responsiblity.

Every state is different but I would definitely check before billing the patient.

Here is a link to TX Medicaid for exception requests.
http://www.tmhp.com/Manuals/TMPPM/Output/2009%20TMPPM%20-%20website-06_TMPPM09_Appeals-17.html

Title: Re: medicaid billing
Post by: Anne on July 14, 2010, 03:56:24 PM
I am unable to bill Medicaid without an authorization -  auth request must be signed by ref. Dr.  - he will not sign the Medicaid auth form with a date several months back.
Title: Re: medicaid billing
Post by: PMRNC on July 14, 2010, 05:04:57 PM
Then, again, you have to check your state Medicaid rules you might be SOL.