Forum - Questions & Answers

Jul 21st, 2015 - IROBERTS

Balance billing Medicaid patients

we are a non par provider with NJ Medicaid...are we allowed to balance bill Medicaid managed care patients for coinsurance/deductibles ...
we are par with Medicare and most other carriers..

I was told there is a Medicaid financial responsibility form for the patient to sign if non par provider with Medicaid...i've never seen it and cant find it on Medicaid.gov or NJMMIS sites..

anyone know the rules or have the form?

thanks!

Jul 22nd, 2015 - mm2394 18 

re: BALANCE BILLING MEDICAID PATIENTS

If the patient is a QMB (Qualified Medicare Beneficiary) meaning that he or she has both Medicare and Medicaid, they can not be balance billed for any deductibles or for co-insurance for Medicare approved cliams. You do not have to be a Medicaid provider to forward the balance to Medicaid. If the amount you received for the service from Medicare is less than the Medicaid fee schedule amount, the Medicaid HMO is responsible for paying you the difference whether or not you are in their network. This is rarely the case, unless it is early in the year before the Medicare deductible has been met.

Here is the link to the MLN publication on the subject.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1128.pdf

Hope this helps.

MM



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