Wiki Medicaid as Secondary

[browninge]

I have a question that I would like some feedback on. My question is how do most of the offices everyone works for handle Medicaid as secondary payer to a PPO. Are your offices accepting Medicaid plans? The issue we are running into is some patients have a PPO plan with a high deductible and Medicaid as secondary. This means that we are writing off the entire bill if everything goes towards their deductible. I am just wondering what some of your offices do? Are they not accepting it as a secondary, or just w/o these type of patients bill. Any feedback would be great! Thanks!

 

[j04gilbert]

If your practice determines that the total financial impact of a payer's fee schedule/payment policies are detrimental to the practice then get out of that contract ASAP. Once the practice or provider (if I'm not mistaken Medicaid will let you par by provider) has cancelled or otherwise gotten out of the Medicaid contract then you would have the ability to not accept patients with Medicaid (primary or secondary). Make sure you post it or otherwise notify patients that you do not accept Medicaid. Patients that decide at a later date to enroll in a Medicaid plan will understand or you can notify them that it will mean they will need to find a new provider.

 

[ckmiotek]

I am not well versed with Medicaid from other states. However, I am in Florida and if the primary insurance has applied all of the services to a deductible we bill it to Florida Medicaid. Florida MCD will pay the claim at the Medicaid Allowable. If the claim is paid by the primary and only a portion is paid, then we check the Medicaid Allowable to see if Medicaid pays more than the primary (which they seldom do) and if they do pay more then we submit to Medicaid. If we know the MCD allowable is less, then we write off as mcd adjustment.
Hopefully this helps.

Bottom Line check the Medicaid allowable for that procedure code if there is an allowable MCD should be paying the claim, no reason to be writing it off.