Wiki Medicare and Medicaid

[amowens854]

I have been having an issue with trying to find information on when patients have Medicare and Medicaid.
An example is that the patient has Medicare and Medicaid, but Medicaid is only family planning. The practice did NOT file the Medicaid b/c we knew that it was only FP but Medicare crossed over the claim to Medicaid. Can we bill the patient b/c Medicaid did not pay?
If you have any documentation to support what your practice follows it would be greatly appreciated. I have looked in a lot of the CMS manuals and such but haven't been able to find the answer.
THANK YOU!!

 

[rachaelwilleford]

We have this happen as well. It is my knowledge that you have to file to Medicaid to get the denial. Typically in this instance, Medicaid will deny as non-covered services after which we bill the patient since their Medicaid coverage only applies to preventative services and family planning.

 

[haraml7]

You would ha e to look at the denial from Medicaid. After they deny is the remark code a CO or PR.
Also, Medicares allowable is probably more than Medicaid you can find this information on the Medicaid website to see what will Medicaid pay.