Billing Commerical & Medicaid Patients

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Hi,
Can someone help with this question.

Say a patient has a commercial insurance for example like Empire BCBS with a $30 co payment and not every visit the patient can pay so as an FQHC we do let some visit's slide and let the patient pay the next time. However in this example the patient hasn't paid a few copay's in several visits and we continue to see her with Empire BCBS (commerical) and she also has Medicaid (straight). Can the biller/FQHC bill the patient's Medicaid to cover the copay amount, legally.

From my perspective we have always strictly billed the patient the co payment or co insurance and never sent it to another payer since these are "dues" the patient owes. And you would also have to monitor to see for example if Medicaid was paying that actual amount and not a penny over or to me that is double dipping.

Help! Please and thank you!:confused:
 
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I don't know how Medicaid of NY functions, but in my state, submitting to Medicaid as secondary depends completely on the type of Medicaid coverage the patient has. There are some Medicaid plans that will cover copays, but these are almost always Medicare/Medicaid dual plans. There have been times, however, where an agreement has been made between our local BCBS and MD for a particular patient regarding copays and deductibles, but that's handled between them, we just submit the claims as they (BCBS) tell us to.

I would first check the provider manuals for MD of NY. If you can't find anything there, I would just call them. Again, I don't know how you're set up with them, but we have a provider contact person at Medicaid that takes care of researching all questions we have.
 

hperry10

Guru
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140
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Hyannis
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Hi,
Can someone help with this question.

Say a patient has a commercial insurance for example like Empire BCBS with a $30 co payment and not every visit the patient can pay so as an FQHC we do let some visit's slide and let the patient pay the next time. However in this example the patient hasn't paid a few copay's in several visits and we continue to see her with Empire BCBS (commerical) and she also has Medicaid (straight). Can the biller/FQHC bill the patient's Medicaid to cover the copay amount, legally.

From my perspective we have always strictly billed the patient the co payment or co insurance and never sent it to another payer since these are "dues" the patient owes. And you would also have to monitor to see for example if Medicaid was paying that actual amount and not a penny over or to me that is double dipping.

Help! Please and thank you!:confused:

I work for an FQHC also and we always bill the copay to the secondary payer (usually Medicaid). In fact, many of our patients refuse to pay the copay if they have a secondary insurance. As the previous poster said, there are some Medicaid plans that do not cover copays so if Medicaid denies the claim or we know for a fact that particular plan does not cover the copay, we bill the patient.
 

JesseL

Expert
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I was told Medicaid is always the payer of last resort.

If you're in new york you should register to use a epaces account on https://www.emedny.org/.

You can submit the claim to medicaid through there and you'll know right away if they'll deny it usually or approve it.
 

decolat

New
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In PA we bill Medicaid as the payer of last resort. If you are contracted with Medicaid, you cannot bill a patient for covered services. If it is not a covered service, I would have them sign a form prior to the visit/procedure informing them of the cost and it was not a covered benefit of Medicaid.

Tracey DeCola
 
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