Author Topic: Medicaid Billing  (Read 1459 times)

Anand

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Medicaid Billing
« on: August 12, 2015, 01:53:22 AM »
One of the providers that we work with, resides in CA - at the present time he hasn't credentialed with Medicaid, he has plans to do in the near future however I have couple of questions

(i) After Medicare pays on certain claims, pt has Medicaid and he/she is eligible - so far we are adjusting the balance OOP( Co-ins/Ded) applied by Medicare. However Dr. wants to know if he can bill % of possible Medicaid collectibles from pt.  We have said its not correct and legal.. Can someone shed some light on that ( and some possible links) I can use to explain this to the DR

(ii) Once he enrolls with Medicaid - can we be choosy in seeing the pt's or he need see all Medicaid pt irrespective of his choice. I think the answer is the later one but wanted to confirm

Can you guys share your thoughts on this.. PL


Anand

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Re: Medicaid Billing
« Reply #1 on: August 12, 2015, 10:10:38 AM »
Can someone pl share your thoughts on this

rdmoore2003

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Re: Medicaid Billing
« Reply #2 on: August 12, 2015, 10:14:21 AM »
Provider cannot pick and choose.  I would look at this link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/california.html

Once networked with medicare and medicaid, you cannot balance bill.
Regina

Anand

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Re: Medicaid Billing
« Reply #3 on: August 12, 2015, 10:28:43 AM »
Thank you Regina, I appreciate it. Also, can you shed some light on billing Medicaid pt's on MCR cost sharing.. (provider is non-par with Medicaid). I know this may sound silly. it would be very helpful to get some link. I have been trying something but couldnt get one..

rdmoore2003

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Re: Medicaid Billing
« Reply #4 on: August 12, 2015, 11:12:09 AM »
If I am understanding the questions correctly, if provider is in network with medicare but not with medicaid, you can charge the medicare copays, deductibles, etc to the patient.  Once the provider is in network with medicaid, you cannot bill patient at all.   
Keep in mind, that all states vary with laws. 


At the top of the page of the link I previously provided, click on "Federal Policy Guidance" at top of page, then under "Frequently asked questions" click on  "For more information about the increased FMAP rates available beginning in 2014 and beyond, click here."  Then on left side of page click "cost sharing".   From there you should be able to find more specifics.   Hope this helps
Regina