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Medicaid

  1. Question Medicaid
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    If anyone knows the laws on this i would greatly appreciate any help i can get....If a patient presents you with a commercial insurance, such as BCBS, and it comes back stating they no longer have coverage with them, and when you contact them they tell you they have the state medicaid. Since they presented you with the wrong card can you bill them even though it is medicaid?

  2. #2
    Location
    Fayetteville, NC
    Posts
    300
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    Do they have Medicaid for the date of service in question?
    Has it been over a year since the date of service?
    There are a number of questions that need to be answered before your question can be answered.
    If they have Medicaid for the date of service in question why not just send the claim to Medicaid?
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  3. #3
    Location
    Concord, NC or Rochester, NY
    Posts
    154
    Default
    Basically the answer is yes you have to accept medicaid.

    This is why most practices check insurance before the patient arrives to understand the issues.

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
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    Quote Originally Posted by laurabryant View Post
    If anyone knows the laws on this i would greatly appreciate any help i can get....If a patient presents you with a commercial insurance, such as BCBS, and it comes back stating they no longer have coverage with them, and when you contact them they tell you they have the state medicaid. Since they presented you with the wrong card can you bill them even though it is medicaid?
    You might not be able to bill the patient.

    Hopefully you are contracted with the state medicaid program, because if you are not contracted with state medicaid you may have to write off the charges. This is avoidable if you have the patient sign a waiver when they check in that states you are not contracted with state medicaid and will not be able to bill that program if the patient obtains that type of coverage.

    This is why more and more physcian offices are checking eligibility on the insurance when the patient schedules, or checks in for an appointment. You can end up providing free care, even tho the patient has not given you the correct information.
    Last edited by ajs; 12-13-2011 at 11:23 AM. Reason: add
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    Thank you everyone for your reply thats what i had thought that you had to have a waiver or you could not bill the patient, but just wanted to make sure.

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