Staying Independent...Together

Print Message

   RE: When your out-of-pocket patient uses Medicaid to pay for prescriptions
 From: Peter Liepmann
 To: Member Forum
 Posted: 12-19-2017 01:27
 Message: IF you participate with Medicaid or a managed-care MCD product the patient is in, you need to have them sign an agreement before you do private pay.  If you don't par in Medicaid or their managed-care MCD product, there's no problem.

Balance Billing: Is It Legal? - AAPC Knowledge Center
Apr 8, 2016 - For Medicaid providers, balance billing is legal:
If the physician does not have a contract with the insurance plan.
If the services are non-covered services (think cosmetic surgery) by the insurance plan.
If the patient chooses to opt-out of using their insurance and be a self-pay patient for any particular service.

In California, MediCal pays $24-35 for an office visit, so you'd have to be plumb loco to participate in MC as a private practice.  MCD pays FQHCs ~$160/visit, no matter what they're for.
Just FYI.

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA
Original Message:
Sent: 12-16-2017 09:36
From: Karen Betten
Subject: When your out-of-pocket patient uses Medicaid to pay for prescriptions

I've also understood it that with my cash-only practice I'm not allowed to charge a Medicaid patient for services that are covered by Medicaid.  I have only a handful of these patients, so I've made the decision just not to charge them for their visit.  I have not had any problem ordering labs or prescribing medications for these patients.

Original Message------

Interesting !  In some states  one cannot see Medicaid patients and have them pay cash- illegal  I am told( is that true? Never saw it in print I admit)
 so,  it would be obvious they would try to get their prescriptions paid for who wouldn't   but the prescription coverage is connected to who wrote for it?? I am not helping you I am sorry  Let us  know
The system  gets  more bizarre daily   I confess I am at my wits end

Jean Antonucci

Copyright 2016 Ideal Medical Practices. All rights reserved.