Medicaid is an insurance program for people of low income and resources who cannot fund their own medical expenses. Medicare is an insurance program that provides health insurance coverage for that age 65 and older and to those under the age of 65 who are permanently physically disabled or have a physical congenital disability. Working with Medicaid and Medicare patients can be challenging when it comes to medical and health care services.
It is possible for a patient to have both Medicaid and Medicare. Medicare covers medical costs, but there are sometimes limits to what it can cover. Medicaid is used to supplement Medicare to pay what Medicare does not cover. Medicaid will cover deductibles and co-payments while Medicare requires small co-payments in some cases. Medicare also reimburses the Doctor more than Medicaid. Determining which entity should be billed is a challenge when working with Medicaid and Medicare patients.
Billing Medicaid or Medicare
Before a service provider can bill Medicaid or Medicare for services rendered, they must determine if there is a primary payer such as a health insurance program or a personal injury protection policy in the event of an accident. For example, someone on Medicaid or Medicare that is injured in an automobile accident and requiring medical attention may be covered under the policy of the person who caused the accident.
The medical service provider is obligated to bill that entity first before billing a government funded health insurance program. If the personal injury protection benefits are not available or have expired, the service provider may bill the next in line such as Medicaid or Medicare.
Working With Medicaid and Medicare Patients
When working with Medicaid and Medicare patients for medical services rendered, the service provider cannot bill Medicaid or Medicare for services after 12 months following the date of the claim. If the service provider is seeking payment from a settlement the injured party may receive the service provider must first cover the claim then place a lien on the settlement.
If the claim is not paid to the injured party, Medicaid or Medicare can be billed, but only within the one year time frame. The provider may seek payment from the settlement in an attempt to cover their entire expenses. Medicaid and Medicare only provide established payments and they are usually less than the real cost. Service providers who accept Medicaid or Medicare cannot bill the patient for the difference in payment.
If the service provider places a lien on a settlement to cover costs for services rendered, and the ultimate settlement is not enough to cover the expenses, the service provider cannot bill Medicaid, Medicare or the patient for the difference, even if the service provider tires to bill those entities within the one year allowable time frame.
Service providers can refuse payments from government funded health plans and decide working with Medicaid and Medicare patients is not good for their business. There is no law that says Service provides must accept Medicaid and Medicare patients, but the service provider is required to make that public information.
