Medical Billing Forum

General Category => General Questions => Topic started by: rlopez32 on August 02, 2011, 12:56:51 PM

Title: Billing Medi-Cal patients
Post by: rlopez32 on August 02, 2011, 12:56:51 PM
Hello Ladies!!

I have a question about California Medi-Cal.

I recently started working for a Neurologist that has a lot of outstanding balances for Medi-Cal patients. He only became effective with Medi-Cal last year. He is an on-call physician at our local hospital and obviously had to see some Medi-cal patients when he wasn't effective. My question is can we bill these patients after the fact since we were not effective with Medi-Cal at the time of service? Or did the patient need to sign consent prior? That seems hard in a hospital setting. I have told him that these will end up all being write offs. He wants to make sure we can not bill the patient. Where would I go to find out the laws pertaining to this situation?!

Thanks ladies!!!
Title: Re: Billing Medi-Cal patients
Post by: Michele on August 03, 2011, 06:12:06 AM
That varies by state and I'm not sure with California.   In many states you are not supposed to treat Medicaid patients if you are not a Medicaid provider and therefore you could not bill the patient.  Anybody know about California??

Title: Re: Billing Medi-Cal patients
Post by: DMK on August 03, 2011, 10:18:34 AM
If it is a covered benefit, and you took the patient KNOWING they were Medi-cal AND you are not participating in Medi-Cal at the time you provided services, you CAN NOT bill the patient.

He CAN bill the patient's who received services once he became a participating provider.  The rest is a write off, sorry.  The only good thing is that the write off shouldn't be too much as Medi-Cal has HORRIBLE reimbursement.