Billing Insurance that Provider Does Not Participate

pwidner1

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10
Location
Belvidere, IL
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Hello,

I need some help. I am new to billing and coding in Kentucky and my new office does not participate with Kentucky Medicaid/ Passport. We will not accept patient's with this insurance but have had patients on occasion not tell us and are self pay or will pay their primary co pay and we find out later they have the Medicaid/ Passport. Do we have to bill Medicaid/ Passport if we seen this patient or can we bill the patient as self pay? In Michigan where I moved from we just billed the patient if we were non participating and patients are told we don't accept the insurance. Office seems to think that we have to bill the insurance if patient has insurance. I don't think so but I need to know if there is a law/ statute that I may be missing regarding this. Thank you.
 

shannaron

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My thought iis that you cannot bill a patient that has Medical Assistance unless they signed a waiver stating they are aware of the non par and will pay the office visit fee. At least that is the way it is in PA.
 

kinger70

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I worked for a providers office in Wisconsin that did not accept Medicaid and we often had Medicaid patients that were willing to self-pay (our providers were specialists and had a fantastic reputation). I was always told by WI Medicaid that we could not accept payment from these patients knowing the type of insurance they had. If we knew they had Medicaid we had to bill Medicaid; accepting payment from them was fraudulent. However, I was told by Illinois Medicaid that if the patient was aware that you were not a participating provider and was willing to pay, it was okay. And they advised that the patient sign a waiver.

I would check with Kentucky Medicaid and see what their response is.
 
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