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Medicare/NC Medicaid

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bumbleb:
Hi all!  I bill for PT.  In NC, Medicaid does not cover PT, unless the pt is under 21.  So we w/o the 20% not paid by MCR.

We have a pt who we were seeing at the beginning of the year.  Apparently, she did not meet her MCR deductible before I filed her claims, and had almost $100 to go.  Since Medicaid covers her MCR deductible, and they normally pay us $0, does that mean we have to w/o the $100?? 

Doesn't see right...
bren

Michele:
Doesn't seem right, but if Medicaid doesn't cover PT over 21, then they aren't going to cover the deductible either.  At least basing that on what you've told me.  You could check with Medicaid to make sure.  Or maybe Charlene knows!   ;D

Michele

Pay_My_Claims:
Medicaid patients can be billed for services that are NON-covered by medicaid. Medicare makes that the patients responsibility. What you have to do is notify the patient PRIOR to services, and bill them the balance. Because medicaid clients are knowledgeable about the rules, you should have them sign the statement of benefits for your records.

Michele:
I knew Charlene knew!  Thanks   ;)

Michele

Pay_My_Claims:
You are more than welcome......I have had medicaid clients call EDS on me for billing them. One had BCBS and Medicaid 2ndary. BCBS paid directly to them, and they got a bill from me about going to collections. They called EDS, and they called me asking me why was I sending a medicaid client to collections. I stated because they SPENT the BCBS check that was to be applied to their balance, and we can't bill medicaid without the EOB and payment from the primary........she said ok, thanks for that. Client calls me back about how can he make arrangements to pay what BCBS paid so the balance can go to Medicaid. Ironically most of the claim went to his deductible, and the check wasn't that large. So GET THEM TO SIGN the acknowledgment and if possible, collect up front.

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