Wiki Medicaid after Medicare????????

[mitzfritz215]

Please help.

I use CollaborateMD. When a claim goes from Medicare to Medicaid and Medicaid does not pay on the charge does the patient owe the balance. These claims come through the system automatically ( I do not enter them into the system other than the initial claim) and when they come back it reads "Due Patient". In other words Medicare gives an allowed amount of lets say $80. Medicare pays $60 and then the claim goes to Medicaid. They don't pay because Medicare paid more than Medicaid allows. Does the Pt in fact owe the balance due from what Medicare allows?
Thanks

 

[crystal.lopez]

No, if Medicaid's allowable is lower than Medicare's then it must be wrote off or adjusted off.

 

[Mjones7]

The patient is not responsible in this instance because as Crystal explained, Medicare paid more than Medicaid would allow for the rendered service(s) upon coorridating the patient's benefits. It sounds as if when your system initially processes the claim from Medicare, it allocates the 20% patient responsibility to patient responsibility then the claim is sent along to Medicaid who denies advising Medicare paid more than they would have allowed and therefore no additional benefits are due. As a rule of thumb, when a patient has both Medicare and Medicaid, it is more likely than not that there will not be an instance in which they will incur patinet responsibility in the event Medicare pays. Best wishes!!

 

[mitzfritz215]

The patient is not responsible in this instance because as Crystal explained, Medicare paid more than Medicaid would allow for the rendered service(s) upon coorridating the patient's benefits. It sounds as if when your system initially processes the claim from Medicare, it allocates the 20% patient responsibility to patient responsibility then the claim is sent along to Medicaid who denies advising Medicare paid more than they would have allowed and therefore no additional benefits are due. As a rule of thumb, when a patient has both Medicare and Medicaid, it is more likely than not that there will not be an instance in which they will incur patinet responsibility in the event Medicare pays. Best wishes!!

Another question if you don't mind.
This system also sends the claim to Medicare and they don't pay on the charge and the full amount is adjusted to 0. Do you know why they do that? I've sent it back through a few times and they still don't pay when I know the Pt has Medicare.
Thanks for all of your help.

 

[mitzfritz215]

Another question if you don't mind.
This system also sends the claim to Medicare and they don't pay on the charge and the full amount is adjusted to 0. Do you know why they do that? I've sent it back through a few times and they still don't pay when I know the Pt has Medicare.
Thanks for all of your help.

Also - if Medicare has a deductible and Medicaid doesn't pay it will the patient owe only the deductible? Just want to make sure I'm doing this right. Thanks

 

[mitzfritz215]

Sorry - another question. Sometimes when it comes back from Medicaid it either reads "Did not pay on the charege" or "Denial". Should it be written off for both or only for "Did not pay on the charge"? When it comes back "Denial" I was thinking it was because they weren't eligible. Sorry for so many questions. I need to understand how this works as I am the lone rookie here trying to do it all at the doctors office. Thanks

 

[mitzfritz215]

The patient is not responsible in this instance because as Crystal explained, Medicare paid more than Medicaid would allow for the rendered service(s) upon coorridating the patient's benefits. It sounds as if when your system initially processes the claim from Medicare, it allocates the 20% patient responsibility to patient responsibility then the claim is sent along to Medicaid who denies advising Medicare paid more than they would have allowed and therefore no additional benefits are due. As a rule of thumb, when a patient has both Medicare and Medicaid, it is more likely than not that there will not be an instance in which they will incur patinet responsibility in the event Medicare pays. Best wishes!!

Sorry - another question. Sometimes when it comes back from Medicaid it either reads "Did not pay on the charege" or "Denial". Should it be written off for both or only for "Did not pay on the charge"? When it comes back "Denial" I was thinking it was because they weren't eligible. Sorry for so many questions. I need to understand how this works as I am the lone rookie here trying to do it all at the doctors office. Thanks

 

[mitzfritz215]

The patient is not responsible in this instance because as Crystal explained, Medicare paid more than Medicaid would allow for the rendered service(s) upon coorridating the patient's benefits. It sounds as if when your system initially processes the claim from Medicare, it allocates the 20% patient responsibility to patient responsibility then the claim is sent along to Medicaid who denies advising Medicare paid more than they would have allowed and therefore no additional benefits are due. As a rule of thumb, when a patient has both Medicare and Medicaid, it is more likely than not that there will not be an instance in which they will incur patinet responsibility in the event Medicare pays. Best wishes!!

Also - if Medicare has a deductible and Medicaid doesn't pay it will the patient owe only the deductible? Just want to make sure I'm doing this right. Thanks

 

[shenell333@yahoo.com]

You should check the patient eligibility it should state whether or not they policy pay part b deductible, coinsurance and copay. From my understanding some mcaid policies only cover Medicare premiums. So if that's the case you can give patient the balance. If you check mcaid and it states paid but you received no payment 9/10 you have to adjusted it off. But call them to check to make sure if you don't understand the explanation of benefits. I hope this helps you out.