MEDI/MEDI WITH SOC

[ReneeGillam CPMA CMOM CMC]

Regarding reimbursement: After Medicare pays, patient has share of cost remaining, Medi-Cal pays less than Medicare, is the patient responsible for any of the balance remaining or is this considered a Medi-Cal adjustment?

 

[SharonCollachi]

If the Medi-Cal EOB shows the patient owes a SOC for that claim, then they have to pay it. If the Medi-Cal EOB shows zero patient responsibility, then it's adjusted off.

 

[ReneeGillam CPMA CMOM CMC]

BILLED AMT 450.00 MEDICARE PAID $ 233.42 MEDICARE ADJ $1 57.07 BAL: $ 59.51

MEDI-CAL EOB shows:
MEDICARE ALLOWED MEDI-CAL ALLOWED
$ 292.93 $ 240.00
COINS $ 59.51 SOC $ 0.00

 

[SharonCollachi]

patient owes nothing, the coinsurance is adjusted off. If the $59.51 (or any part of that) was after SOC, the patient would owe what was after SOC.