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I had planned on joining in this morning especially since I have a bunch of experience with the dual market. Of course, I forgot.
Why didn't you call me just before the start of the call to remind me?
Rick
Dual Eligible Question
- Thread starter jmarkk1
- Start date
I had planned on joining in this morning especially since I have a bunch of experience with the dual market. Of course, I forgot.
Why didn't you call me just before the start of the call to remind me?
Rick
Sorry, Rick, LOL. I'll yell at Mike, he is in charge of telephonic personal reminders to SIMA members. heh heh.
If you like, you can comment on the log we posted there (see NEW section for link to post)... it was a pretty active discussion even without your expert commentary ... although probably not as good as it woulda been...
Thanks!
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Rick my bad! Mark has put me on double secret probation.
Josh is right on. To overview this:
Medicaid will always pay last.
Medicaid providers cannot balance bill for services.
MA plans (SNP or Regular) will pay first, and Medicaid will pay the remaining balance up to the Medicaid contracted amount. Any remainder has to be written off by the provider.
A provider who takes Medicaid but is not in network (mostly with HMO plans) can refuse to see the client. Should they? I am not sure, but either way if the client is turned away they are going to be rather upset and prob cancel the plan, and maybe make the agent's life difficult with some calls.
I have sold numerous plans to folks who are dual eligible, both SNP and regular MA plans, and for billing purposes, the provider will treat them the same (just my experience).
Just remember that every state is different, so your results may vary!
Josh is right on. To overview this:
Medicaid will always pay last.
Medicaid providers cannot balance bill for services.
MA plans (SNP or Regular) will pay first, and Medicaid will pay the remaining balance up to the Medicaid contracted amount. Any remainder has to be written off by the provider.
A provider who takes Medicaid but is not in network (mostly with HMO plans) can refuse to see the client. Should they? I am not sure, but either way if the client is turned away they are going to be rather upset and prob cancel the plan, and maybe make the agent's life difficult with some calls.
I have sold numerous plans to folks who are dual eligible, both SNP and regular MA plans, and for billing purposes, the provider will treat them the same (just my experience).
Just remember that every state is different, so your results may vary!
- 15,319
Here's what happens many times and why docs who are in the Medi-Medi system tend to run a bunch of (maybe unnecessary) tests.
Medicare pays 80% of their allowable.
Medicaid allowable usually under that 80% figure.
Medicaid tells docs "You've been paid more than our allowable. Go away."
So for many procedures the doctor is working on 80% of Medicare allowable.
Just wait until Congress passes the doc fix.
Rick
- 523
For individuals that are on both Medicare and Medicaid will the doctor's office receive higher reimbursements for medical services if the patient is switched to a MA plan? Since Medicaid is their supplement is the doctor's office better off financially if these dual eligible patients are put on MA plans?
- Thread starter
- #38
When you are dealing with a dual it could be anything. He may not be showing the card, his Medicaid could be inactive if DHS sent a questionaire out, he could be confused.......
- Thread starter
- #40
