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CAN WE BILL MADICAID WHEN IT IS SECONDARY INS FOR THE PATIENT

BILL PATIENT
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Author Topic: CAN WE BILL MEDICAID WHEN IS IS SECONDARY  (Read 4347 times)

swamy

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CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« 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?

Michele

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #1 on: June 03, 2009, 06:34:30 AM »
Medicaid should make payment.  Any balance after Medicaid makes payment would be written off.

Michele
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swamy

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #2 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.

Michele

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #3 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
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PMBS

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #4 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
MR

swamy

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #5 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.

Michele

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #6 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. 

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Pay_My_Claims

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #7 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??

PMRNC

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #8 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
Linda Walker
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Pay_My_Claims

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #9 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.""

lhough

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #10 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.
Thanks,
Lesley

PMRNC

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #11 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.
Linda Walker
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Pay_My_Claims

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #12 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??

PMRNC

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #13 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.
Linda Walker
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Pay_My_Claims

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Re: CAN WE BILL MEDICAID WHEN IS IS SECONDARY
« Reply #14 on: June 18, 2009, 10:01:32 AM »
I drink sometimes so I thought I was delusional !!!  ;D