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Wiki Is DSHS required to pay balance after Medicare?

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l1ttle_0ne

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Our CEO is stating that when DSHS is secondary to Medicare they are required to pick up what Medicare did not pay. I (and all the other billers in our office) have always been told that DSHS processes secondary claims under their fee schedule. If DSHS says to write off because they allowed less, then that is what you do. Can anyone clarify??? He made it sound like its a "federal regulation". I've asked him to provide me proof, as he wants all of these claims appealed. Any knowledge you guys have would be much appreciated. Thanks!
 
In the state of California you are correct. I would advise you to look up the state regulations concerning secondary payor policies. There are some cases where a procedure is paid by the secondary that is not allowed by Medicare, however this is not common.
 
Thank you. I was able to find it in our Washington stat Medicaid billing guide. It says very plainly that they will allow whatever is the lowest amount.
 
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