I often receive questions from providers of outpatient therapy services who see Medicare beneficiaries that have Medicaid as their secondary wondering if they can bill the patient for the 20% that Medicare does not pay since either they, the provider, don’t participate with Medicaid or Medicaid is not paying the 20% of the Medicare allowed amount. The simple answer is
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What if the primary is a commerical insurance company? Can we collect a co-pay even though the patient has medicaid as a secondary?
If it’s a copay of the primary insurance, my opinion is yes.
In private practice, in most cases, should therapy claims get paid on Medicaid secondary crossover claims (Medicare is primary) if the therapist each have their own Medicaid # & it appears their category of service with Medicaid is accurate? Thanks!
This is not a question I can answer is because the Medicaid program is state specific and they all have their own rules and regulations.
What if the primary insurance is a United Healthcare Medicare Advantage Plan (HMO)? Our clinic does not participate with Medicaid, and our contract with Medicare states that we must accept assignment and not bill the patient for a Medicare/Medicaid scenario. Am I correct in my assumption that the HMO is technically a commercial UHC plan, so the Medicare contract does not apply, and the patient is liable for the copayment?
When we mention Medicare, that is traditional Medicare and not Medicare Advantage plans.