Question: I do billing for a Primary Care physician and I have the following questions. I would appreciate very much any answers/insight you could provide.
- We have many situations where Medicare is primary and Medicaid (Illinois Medicaid) is secondary. When we receive 80% of the allowed amount from Medicare, we bill Medicaid. However Medicaid determines no more payment is due since Medicare already paid more than the Medicaid- allowed amount. In this case can we bill the patient for the 20% oustanding amount?
- Are we obligated to adjust-down the allowed amount for the claim from Primary's allowed amount to Secondary's allowed amount?
the patient-responsible amount shown on the Secondary EOB is less than the patient-responsible amount shown on the Primary EOB, are we obligated to adjust the patient-responsible amount to match that shown on the Secondary EOB? Say, the co-pay for the Primary is $20 and the seondary is $15, are we obligated to charge the patient $15 for co-pay or can we leave it at $20?
Answer: Let's answer these in order.
1. No, you can't bill patients for any balance after Medicaid, unless Medicaid has given specific permission to do so (such as spend down amounts or non-coverage). However, you should still bill Medicaid for the rejection, as you may be able to submit that information for Medicare Bad Debt later on and get some kind of reimbursement for it.
2b. This is the same answer as the first, that being that it's dependent upon whether your facility is contracted with the secondary insurance company or not.