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Is billing Medi-Cal patients for their 20% of Medicare allowable legal?

Marina Posted Tue 23rd of July, 2013 16:10:40 PM

We are not contracted providers with Medi-cal, however, we are contracted providers with Medicare. We have been charging Medi/Medi patients for their 20% of Medicare allowable at the time services are rendered. We also inform the patient before their appointment that we are not Medi-Cal providers and they will responsible for their 20% of Medicare allowable as well as have them sign a form acknowledging they will be resposible for their 20% at the time the service is rendered. A rep from Medi-Cal says it is not illegal as long as we inform the patient prior to their appointment, however, patients are telling us it is illegal. Is it legal to bill Medi/Medi patients for 20% of Medicare allowable as not a contracted Medi-Cal provder?

Marina Posted Wed 24th of July, 2013 21:43:47 PM

Is anyone reviewing this question?

SuperCoder Answered Wed 24th of July, 2013 22:00:32 PM

Yes, we have this question with our senior editor. She is already working on this. We will answer this soon.

Thanks for being patient.

SuperCoder Answered Thu 25th of July, 2013 22:35:19 PM

Hi there,

My Senior editor responded:

In her words :

"The questioner knows the answer. Dual eligible patients with Medicare / Medicaid cannot be balance billed even if caid does not pay the balance bill. This is in the law and the patient cannot sign that they will pay the balance."

I hope this helps

Marina Posted Thu 25th of July, 2013 23:02:03 PM

Thank you

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