Medical Billing Forum

Billing => Billing => : kclayton December 22, 2011, 11:51:01 PM

: Non-Par w/ Medicaid but patient needs care
: kclayton December 22, 2011, 11:51:01 PM

I have a question.  We are not yet approved with a few medicaid states.  We have a petient in one of those states but still wants the DME product.  Can I charge he patient even though he has medicaid (we will not be billing medicaid)?  Do I charge the patient the amount I subit to medicare?  Medicare allowable?  Thanks for your help.

: Re: Non-Par w/ Medicaid but patient needs care
: Michele December 23, 2011, 10:10:00 AM

You need to check the state laws for that state.  Each state has different laws on if Medicaid eligible patients can be billed.

: Re: Non-Par w/ Medicaid but patient needs care
: PMRNC December 23, 2011, 11:47:03 AM

In most states it's no, because they have access to a Medicaid provider. Defeats purpose of patient's eligibility of Medicaid. If the provider takes the patient it will be at their own loss.

: Re: Non-Par w/ Medicaid but patient needs care
: SLITTLES December 29, 2011, 03:25:08 PM

The patient would need to find a Medicaid provider that is contracted with their state.  Also your services should have one price regardless of payor source.

: Re: Non-Par w/ Medicaid but patient needs care
: pvtbiller January 04, 2012, 11:52:17 PM

we are a sole source manufacturer and provider so they would not be able to find a participating provider.

: Re: Non-Par w/ Medicaid but patient needs care
: Michele January 05, 2012, 10:01:07 AM

Sounds like an unusual situation.  Maybe you should contact Medicaid to find out if they make exceptions in these circumstances.