Practice Management Alert

Question: A patient has a Medicare replacement plan and then has Medicaid as secondary insurance. On one of her claims Medicare paid more than the allowable by Medicaid. Therefore, Medicaid will not pay. The patient has a $33.00 balance. Do I adjust the amount or bill the patient? South Carolina Subscriber Answer: You have to write off the $33 outstanding balance. You cannot bill the Medicaid patient. Keep in mind: Medicaid patients are also not responsible for the Medicare deductible or the 20-percent coinsurance when Medicare has paid more than the Medicaid allowable for the service, even though Medicare has only paid 80 percent of its allowable and may have deducted the patient's outstanding deductible from that payment. However, if Medicare has subtracted the patient's deductible from the physician's payment, and the total payment is less than Medicaid's allowed charge for the service, Medicaid should pay that portion of the [...]