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   RE: When your out-of-pocket patient uses Medicaid to pay for prescriptions
 From: Kathy Saradarian
 To: Member Forum
 Posted: 12-19-2017 07:49
 Not the same in every state. 

Kathleen Saradarian,  MD
Quality Family Practice
Branchville, NJ 

Sent from my Verizon, Samsung Galaxy smartphone

------Original 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

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