Wiki medi/medi payment for hospital stay

[jeanettequintero44]

Hello fellow peeps, I work for SNF and a resident of ours was admitted to the hospital for 2 days. For that month I totally forgot and billed Medi-cal (medicaid) for resident's full month stay at our SNF. Now the hospital is charging us the 2 days that they got denied from Medi-cal.

My question is, if they got per say $744.98 from Medicare already for those 2 days, why would they charge us (SNF) $7116.92 for the Medi-cal portion of it? Doesn't it apply to hospital (impatient) too, the 80% Medicare and 20% to secondary (Medi-cal)? Please shine some light on this for me.

Thank you!!

 

[sls314]

I'd suspect that they send the bill for the full billed charges, which is how a secondary claim would be billed.

That being said, I don't know how Medi-Cal would prefer this to be handled. However, I worked Medicaid claims for a hospital in Ohio. I never billed the SNF directly. I just asked them to submit a corrected SNF claim, so that I could get my hospital claim paid by Medicaid.

I'd make sure that you aren't just supposed to refund Medi-Cal for those days, so that the hospital claim doesn't incorrectly deny.