Medicare Primary, Medicaid Secondary

Billing500

Networker
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47
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0
I have a question regarding a providers ability to balance bill. The provider is in-network with Medicare, but does not accept (and is not in-network with Medicaid).
Can the provider balance bill the patient the 20% coinsurance which Medicare does not cover, despite the patient being enrolled in Medicaid (as secondary)?

Thanks.
 

sherri greenwood

Contributor
Local Chapter Officer
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10
Location
Fort Smith, AR
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Was the patient made aware at time of service or when the appointment was scheduled that you do not accept Medicaid? It is my understanding that with Medicare you have to collect the deductible and the co insurance so I wouldn't see a problem balance billing the patient the 20%.
 

mhstrauss

True Blue
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1,241
Location
Baton Rouge
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Was the patient made aware at time of service or when the appointment was scheduled that you do not accept Medicaid? It is my understanding that with Medicare you have to collect the deductible and the co insurance so I wouldn't see a problem balance billing the patient the 20%.
There are laws in place that may prohibit you from from balance billing, even if you don't accept Medicaid. This varies by state, and the particular type of Medicare/Medicaid program the patient qualifies for (some are dual-eligible, others are Qualified Medicare Beneficiary, etc). This article has lots of info:

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

amaurer

Guest
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Yes, you can collect Medicare assigned balances due

Yes, it is legal to collect monies with Medicaid secondary if your office and providers are not contracted with Medicaid. However, if you have a financial assistance program, I would offer them a hardship discount.
 
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Yes, it is legal to collect monies with Medicaid secondary if your office and providers are not contracted with Medicaid. However, if you have a financial assistance program, I would offer them a hardship discount.
This is incorrect. The previous post regarding the possibilities of dual-coverage plans, etc is exactly how the laws work. As far as a financial assistance program goes, you need to tread lightly when it comes to adjusting off balances due by the patient after Medicare pays. That gets into anti-kickback regulations and similar laws.
 
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