Wiki Office Policy vs. Medicaid Contract

[medcode12]

Does an office policy override a contract with Medicaid?

Providers of Medicaid strictly because of hospital rounds, but office policy is to not bill for Medicaid in an office setting. Is this a breech in contract? Can you choose to be a Medicaid provider for hospital setting, but not bill for in office setting services?

Some patients still want to be seen and pay cash. The patient is informed that we do not bill Medicaid in the office setting and are referred out for the most part, but some do slip through the cracks. A waiver is signed for all self pay patients stating they agree to pay the charges as billed by the office and will not submit charges to any other available coverage.

Considering opting out of being a Medicaid provider to avoid any fraud.

Any thoughts would be appreciated.

 

[mitchellde]

The patient has Medicaid due to financial concerns. You cannot agree to see the patient outside of the restrictions place on them by being a Medicaid recipient, and you cannot let them agree to pay outside the system. Medicaid is a restricted access system for a reason, you as a provider cannot remove the barriers.

 

[medcode12]

Thanks for the reassurance. If a doctor is contracted with Medicaid, can they choose to not accept it in the office setting and only bill when needed for hospital services?

 

[mitchellde]

no you cannot. The patient is Medicaid and if you are not contracted the patient will need to seek services from a Medicaid provider.

 

[dclark7]

It depends on the state. I've been doing some research for my company and in some states you can see medicaid patients as self pay (New York and North Carolina are two examples). In order to see them as self pay they have to be informed in writing prior to the initiation of treatment that you are seeing them as self pay and they have to agree in writing to be responsible for the charges.

Your best bet to get correct information on these types of questions is to go to the state websites and read the provider manuals. Most states have them posted online and that way you have your state guidelines and you have them in writing.