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LCSW/Medicaid in NYS

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Christy:
thanks, Michele! :)

Christy:
I have another question on this topic:

The LCSW is par with Medicare and NYS Medicaid. She billed 90834 (2013 claim.) Medicare allowed $61.83 and paid $39.39 with a patient resp of $21.64. Medicaid paid $4.33 on that claim (the patient is a QMB.) Can the provider balance bill the $17.31 to the patient???

Or is the $4.33 based on the Medicaid rate, which perhaps trumps the Medicare rate???

thanks!!! :)

shanbull:

--- Quote from: Christy on February 19, 2014, 03:18:07 PM ---I have another question on this topic:

The LCSW is par with Medicare and NYS Medicaid. She billed 90834 (2013 claim.) Medicare allowed $61.83 and paid $39.39 with a patient resp of $21.64. Medicaid paid $4.33 on that claim (the patient is a QMB.) Can the provider balance bill the $17.31 to the patient???

Or is the $4.33 based on the Medicaid rate, which perhaps trumps the Medicare rate???

thanks!!! :)

--- End quote ---

Medicaid has its own fee schedule, so it will only pay the remaining difference between its own rate and what Medicare paid. If its fee schedule rate is lower than what Medicare already paid, Medicaid pays nothing. We always have to write off any remaining balance once Medicaid makes its decision because it is a contractual obligation for us. I assume this is true for everyone who is par, but make sure you look at the wording of the Medicaid remittance and whether the adjustment codes say "CO" or "PR". QMB patients are rarely held responsible for a remaining balance.

Christy:
thank you, shanbull!

Christy:
Here's another question.

Patient has managed Medicare primary (Fidelis Dual Advantage) and straight Medicaid as 2ndry. Fidelis managed Medicare applies a service performed by a LCSW-R to the deductible. Will straight Medicaid over this deductible?

if not, can the patient be billed this amount?

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