Wiki Billing a Medicaid patient?

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mnuhfer04

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North Tonawanda, NY
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I am pretty sure I know the answer already, but I wanted some opinions.
Is it ever legal to bill a Medicaid patient?
Example:
A patient has a Medicaid managed plan through BlueCross. We do not participate with BlueCross, we do with Medicaid. Can the patient sign a waiver to pay cash since we don't participate with BlueCross? My answer is no, we cannot bill the patient even when a waiver is signed. My office manager disagrees and says yes with a waiver, we can collect cash from the patient. (we are in NY)

Advice would be greatly appreciated!
 
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mnuhfer04 said:
I am pretty sure I know the answer already, but I wanted some opinions.
Is it ever legal to bill a Medicaid patient?
Example:
A patient has a Medicaid managed plan through BlueCross. We do not participate with BlueCross, we do with Medicaid. Can the patient sign a waiver to pay cash since we don't participate with BlueCross? My answer is no, we cannot bill the patient even when a waiver is signed. My office manager disagrees and says yes with a waiver, we can collect cash from the patient. (we are in NY)

Advice would be greatly appreciated!
Click to expand...

Your manager is correct - this question is answered in the NY State Medicaid program policy manual which you can find at this link:

From the section titled 'When Medicaid Enrollees Cannot be Billed' beginning on page 10 - it explains that yes, the patient may sign a waiver to pay cash, but you must also explain to the patient that they could obtain the covered services at no cost from a network provider:

A provider who participates in Medicaid fee-for-service but does not participate in the enrollee’s Medicaid Managed Care Plan may not bill Medicaid fee-for-service for any services that are included in the Managed Care Plan, with the exception of family planning services. Neither may such a provider bill the enrollee for services that are covered by the enrollee’s Medicaid Managed Care contract unless there is a prior agreement with the enrollee that he/she is being seen as a private patient as described above. The provider must inform the enrollee that the services may be obtained at no cost to the enrollee from a provider that participates in the enrollee’s Managed Care Plan.

Private Pay Agreement
A provider may charge a Medicaid enrollee, including a Medicaid enrollee enrolled in a Managed Care Plan, ONLY when both parties have agreed PRIOR to the rendering of the service that the enrollee is being seen as a private-pay patient. This must be a mutual and voluntary agreement. It is suggested that the provider maintain the patient’s signed consent to be treated as private pay in the patient record.
 
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Good morning,
We have this same issue in our office. I am understanding as long as they sign the waiver stating your office doesn't participate with the Medicaid plan you can bill the patient. My reasoning is at this point you let the patient know your office don't participate and that they are still choosing to be seen at which point you would enter them as a self pay patient.
 
0
thomas7331 said:
Your manager is correct - this question is answered in the NY State Medicaid program policy manual which you can find at this link:

From the section titled 'When Medicaid Enrollees Cannot be Billed' beginning on page 10 - it explains that yes, the patient may sign a waiver to pay cash, but you must also explain to the patient that they could obtain the covered services at no cost from a network provider:

A provider who participates in Medicaid fee-for-service but does not participate in the enrollee’s Medicaid Managed Care Plan may not bill Medicaid fee-for-service for any services that are included in the Managed Care Plan, with the exception of family planning services. Neither may such a provider bill the enrollee for services that are covered by the enrollee’s Medicaid Managed Care contract unless there is a prior agreement with the enrollee that he/she is being seen as a private patient as described above. The provider must inform the enrollee that the services may be obtained at no cost to the enrollee from a provider that participates in the enrollee’s Managed Care Plan.

Private Pay Agreement
A provider may charge a Medicaid enrollee, including a Medicaid enrollee enrolled in a Managed Care Plan, ONLY when both parties have agreed PRIOR to the rendering of the service that the enrollee is being seen as a private-pay patient. This must be a mutual and voluntary agreement. It is suggested that the provider maintain the patient’s signed consent to be treated as private pay in the patient record.
Click to expand...
Thank you so much for this information! I hadn't had time to look on Medicaids website yet today, so this is very helpful!
 
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