Medicare and Medicaid billing

[Dr. B]

I'm located in Missouri. I'm in the process of setting up a new office and want to get signed up as a Medicare provider. Am I required, in being a Medicare provider, to also accept the state's Medicaid program for the exam supplemental or for the glasses. thanks for any help.

Matt

[becc971]

If you give me your e-mail i will send you all of the medicare documents i have found to use as far as billing glasses. they're confusing, boring, but incredibly useful :)

[jpways]

From a purely CMS prescriptive they do not require you to take Medicaid in order to accept Medicare payments (and I am basing this on the fact that I have never been asked for a Medicaid provider number in filing out any Medicare enrollment applications and our office is both a part B and DME provider, and I've done both recredentialings in the previous 2 years).
However, I don't enough about the federal rules to know whether you are allowed to charge a Medicaid member their coinsurance if you are not a Medicaid provider. We do not because it's usually a waste of money to collect it. But I do know according to the rules Medicaid plans are allowed to reduce coinsurance payment to 0 and you are not allowed to charge the balance that Medicaid does not pay (Balance bill) <Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf>

[becc971]

Also, on bsmconsulting.com they have courses on medicare compliance

[Jubilee]

You are not required to be a medicaid provider. The situations that will get tricky will be those who Dual Eligible. These are folks who are on Medicare, and may use Medicaid as a supplement. There are multiple types of dual eligibility. The main thing you will have to remember is you CAN NOT BALANCE BILL for anyone with QMB (Qualified Medical Beneficiary) status. The state ran medicaid programs are the ones responsible for providing the co-insurance on that bill.

With QMBs, if they are QMB ONLY it means that they only qualify for Medicare services. Medicare will "cross-walk" the claims with Medicaid and eventually you should receive the money.

If they are QMB PLUS, then they are eligible for Medicare and Medicaid services (vision and dental in most cases.) For these services they should be seen by a Medicaid Provider.


Here's a link you might find useful: https://www.cms.gov/Outreach-and-Edu...ads/SE1128.pdf

https://www.cms.gov/Outreach-and-Edu...t_a_Glance.pdf