Payments > Patient Billing

medicare deductibles and coins

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sassie42:
i work for a dme company in florida.   we are non par with all insurances. have #'s but no par.  big debate, my question is: can you bill patients for there medicare deductible and or coins if they have medicaid as secondary and medicaid denied pymnt of deductible or coins????  some people say yes others say no. but if all the claim went to pt deductible we wont see a dime if medicaid denies pymnt too.  we cant just eat the costs we need paid for services cant just write it off.

Pay_My_Claims:
I work DME as well, and it doesn't matter what type of services...you can only bill if medicaid denies and the denial states it is patient responsibility. Why is Medicaid denying?? This is where you need to start first. We have clients that have what they call QMB medicaid in NC. This only covers the Medicare Pt B premiums. This means the client does not have full medicaid benefits therefore the balance after Medicare and the medicaid denial makes the patient 100% responsible for the balance. Please feel free to email me if you need to.

PMRNC:
Wouldn't you need to have an ABN on file?

Pay_My_Claims:
question is will that ABN work when you have a 2ndary insurance???  I think his issue is medicare is paying and his 20% is being denied by caid. There are items not allowed by caid in NC and what we do is yes have them  pay up front and file non-assigned. They really need to show why caid is denying before it can be resolved.

PMRNC:
Doesn't matter about coverage so long as Medicare is PRIME, the ABN is for Medicare and if the balance due is the deductible and coinsurance from Medicare the ABN should be fine.

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