Medicaid out of state

kcarlyle

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Does a provider have to write off a charge if the out of state Medicaid denies as provider not contracted for service? Is a provider required to bill out of state Medicaid for services? Can an out of state Medicaid patient be sent to collections? We consulted on an out of state Medicaid patient in the hospital.
 

sarowe

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RE: Out of state Medicaid

If the patient is a Qualified Medicare Beneficiary, the provider is not able to bill them. Billing a dual eligible QMB is prohibited per the CMS guidelines. As far as I know, the only way to tell if a patient is a QMB is to check eligibility with Medicaid (they will tell you if the patient is considered a QMB). If the patient is not a QMB, I believe that the provider is able to bill the patient if they are not contracted with the Medicaid plan and with that being said, I believe they can be sent to collections if your billing efforts prove fruitless. I have pasted a link to CMS' guidelines below so you can have more information:

https://www.cms.gov/Outreach-and-Ed..._Beneficiaries_Dual_Eligibles_At_a_Glance.pdf

Hope this answers your questions!

Samantha
 

jflynn124

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If the patient was admitted on an emergent basis, the denial can be appealed with documentation. If not, you have to adjust the charge. It doesn't matter what state the patient lives in, they cannot be billed nor sent to collections. The only exception is if their coverage lapsed for that period of time.
 
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