Hello. I'm new in billing. Does anyone know if we're allowed to bill patient for deductible/co-insurance if we're not participating provider with Medicaid? I was told by 1 representative of Medicaid that we're not allowed to bill patient for the balance if we do not participate. Any feed back will help. Thanks.
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Wiki Medicaid
- Thread starter mye1424
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JCaillouet
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Think you mean Medicare as Medicaid doesn't have as far as I know deductible / coinsurance.
From the AAPC itself:
https://www.aapc.com/blog/34357-balance-billing-is-it-legal/
From the AAPC itself:
https://www.aapc.com/blog/34357-balance-billing-is-it-legal/
Let me clarify my question..
We are not a participating practice with Medicaid. But we see Medicaid pt if its Medicaid secondary only. If pt has medicare primary and Medicaid secondary, we accept what medicare pays and write off the coinsurance. In the beginning of the year Medicare has a deductible and crossover to Medicaid, since we do not participate with Medicaid what happens to that deductible amount? Do we bill patient for the deductible? Hope this help?
We are not a participating practice with Medicaid. But we see Medicaid pt if its Medicaid secondary only. If pt has medicare primary and Medicaid secondary, we accept what medicare pays and write off the coinsurance. In the beginning of the year Medicare has a deductible and crossover to Medicaid, since we do not participate with Medicaid what happens to that deductible amount? Do we bill patient for the deductible? Hope this help?
thomas7331
Guest
Medicaid plans, benefits, and regulations are administered at the state level and so will vary from state to state. To get a definitive answer to this question, you would need to look at your particular state's Medicaid laws and plan guidelines or contact your state plan. Most states post a provider manual on their web site which usually will outline the circumstances in which you are allowed to bill a Medicaid beneficiary. These are typically limited situations that require the provider to notify the patient in writing prior to providing the service. I'd recommend also looking into whether or not it is really necessary for your provider to be participating with Medicaid in order to be able to receive eligible reimbursement from Medicaid for Medicare cost-share. I believe that some states may cover the Medicare cost-share for dual-eligible beneficiaries without necessarily requiring a participation agreement in the Medicaid plan.
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cbosi1
Contributor
Hi, I am a coder in NC and we have the same question. Is there anyone from NC that knows the answer to this question? Thanks so much.