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Medicaid as primary or secondary- Can we charge the patient if they dont pay?

  1. #1
    Default Medicaid as primary or secondary- Can we charge the patient if they dont pay?
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    if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can't trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.

  2. #2
    Location
    Columbia, MO
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    13,258
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    unless the patient has a form of Medicaid where they are required to pay a certain amount of the balance then no you cannot be collecting from the patient if Medicaid does not pay. Spend -down Medicaid that some states still have is a type where the patient would owe a portion. However the EOB would indicate this. If it was a denial by Medicaid the no you cannot collect from the patient, you might can appeal the denial depending on the reason.
    Remember those granted Medicaid are person that are financially as well as medically indigent, so in actuality you would be trying to collect from a patient that has not the funds to pay you.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Charging Clients in Medicaid
    I would check with your state Medicaid Agency. In our state (Oregon), in general providers are not allowed to bill clients for covered services. Our rules state that prior to the provider providing a non-covered service, they have to have the client sign a waiver notice or ABN prior to receiving services, then they can bill the client. If the provider failed to have the client sign the ABN, then they can't bill the client.

    Willie V.

  4. Default
    In my experience if Medicaid is denying "Capitation MCO" the client may have a Managed Care plan that is liable for the charges. Check Epaces for a Medicaid Managed Care plan and bill to them. .

  5. #5
    Location
    Santa Rosa
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    15
    Default Qmb
    Quote Originally Posted by Jm6161 View Post
    if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can't trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.
    If your practice is enrolled as a Medicare or a Medicare advantage plan provider then you are prohibited from balance billing Medicare deductibles, coinsurance, or copays from dually eligible (Medi-Medi or QMB) individuals.

    https://www.cms.gov/Outreach-and-Edu...ads/SE1128.pdf

    This though, doesn't mention if the patient has a Medicaid cost share that hey need to meet, only the cost sharing attributed to Medicare.

  6. #6
    Default To charge or not to charge a Medicaid Patient-- Thank you
    Medical Billing
    Thank you everyone for your help on this. This for the state of Illinois Medicaid. So I need to researched it a little more. Anyone know how medicaid works in Illinois?

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