Medical Billing Forum

General Category => General Questions => Topic started by: Lesa on October 28, 2017, 10:18:02 PM

Title: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: Lesa on October 28, 2017, 10:18:02 PM
We are Psychiatric group (4 MD's) & we have hired a new biller that states if a pt has a commercial insurance as primary & Georgia Medicad as a secondary that you CAN collect deductibles and copays from the patient the day of the appointment. Is that true? We are in network with both. We just started taking GA Medicad so I am not the experienced with Medicad but I was always told you can not collect anything from a Medicaid pt.No missed appointment fees, etc..

Example... BCBS pt with a $6000 deductible that had not been met, Medicad as a secondary, and the biller told the pt she owed $300 for the visit since she hadn't met her deductible and " GA Medicaid doesn't pick up deductibles or copays"
Can someone please help me? I have exhausted all avenues trying to find the answer to this question.  It is literally tearing our office apart.

P.S. if you can NOT collect commercial deductibles  & Medicad doesn't pick up commercial copays and deductibles how can doctors possibly stay in business?
Thanks for any help
Title: Re: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: Michele on October 30, 2017, 07:31:00 AM
That definitely does not sound right to me.  I know for sure in NY you CANNOT bill a patient who is Medicaid eligible.  I'm not sure specifically with GA however, if the primary applied to the deductible and you are billing GA Medicaid as secondary then they will be paying so why would you collect from the patient before knowing what the secondary is going to do?  All of the Medicaids I am familiar with do not have a deductible so they will be making payment and since you are participating with Medicaid you have to accept their allowed amount so collecting from the patient before billing Medicaid will cause a financial nightmare.  And IF the patient did pay (which if they most likely cannot shell out that kind of money because if they could they wouldn't be Medicaid eligible!) there are going to be refunds galore! 

Medicaid usually pays if secondary when the primary applies to the deductible.  They only pay up to their allowable, but they pay.  In NY they also pay copays.  From a quick search I see that GA Medicaid covers the Medicare deductible so it should also cover a commercial insurance deductible as well. 

Does your biller think that Medicaid is not going to cover these and if so, why?

The whole thing just doesn't sound right to me at all.  Without knowing your biller's side it's hard to give a fair judgement but it sounds very strange. 
Title: Re: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: PsychBiller on October 30, 2017, 01:21:05 PM
I bill GA Medicaid daily, and you cannot collect anything at the time of service, GA Medicaid most certainly does pick up deductibles and copays.
Title: Re: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: Michele on October 30, 2017, 08:08:25 PM
I bill GA Medicaid daily, and you cannot collect anything at the time of service, GA Medicaid most certainly does pick up deductibles and copays.

Thank you!   I was sure that it couldn't be right but I don't bill GA Medicaid so I'm so glad you confirmed it.  Lesa, is this new biller in house? 
Title: Re: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: PMRNC on October 31, 2017, 06:28:56 AM
MOST states won't allow you to bill Medicaid patients, there are a few that you can OR if the patient has a Medicaid managed care plan.

There are still group plans that offer really high deductible/coinsurance to employees at a NON contributory rate (meaning the employee doesn't pay) and their income still falls low enough to qualify for Medicaid. So they get the plan for catastrophic coverage (doesn't cost them anything) and Medicaid will pick up the bills. That's the logic behind that, so if you think about it why would the patient have Medicaid only to have to meet the primary insurance's out-of-pocket in order to receive the benefit of Medicaid.

If you submit to Medicaid they will pay their portion and you will see on the EOB PR would be $0. (Unless it's a Medicaid Managed care Plan)

Title: Re: I beg for your help! BCBS, GA Medicad, and deductibles
Post by: rballinger1 on November 13, 2017, 10:48:22 PM
We bill both BCBS of GA, and Medicaid/Medicaid HMO Plans.  If the patient has Medicaid it is always billed after the primary (BCBS in this case).  If the provider does not participate with Medicaid, or if the service is not covered by Medicaid you can collect from the patient upfront but the patient must sign an ABN, or advanced notice of responsibility and include the reason the patient is responsible.