Policy Allows Medicaid to Pay Claims for Patients Eligible for Medicare

Posted on January 03, 2019

On Nov. 30, the Medical Services Administration released a final policy that modifies the billing process for services provided to Medicaid beneficiaries in fee-for-service (FFS) and managed care organization (MCO) plans who, as of their date of service, are eligible for Medicare but are not yet enrolled. The new policy, which took effect Jan. 1, includes beneficiaries that are only partially enrolled in Medicare, such as those enrolled in Medicare Part A and not Part B.

Medicaid policy previously required Medicaid FFS and MCO plans to reject claims for services provided to these individuals, which has often caused hospitals to write off accounts and incur bad debts. The new policy allows Medicaid FFS or MCO plans to pay these claims as the primary payer before the patient applies for Medicare coverage.

In cases where the patient obtains Medicare coverage retroactive to the date of service, the provider should bill Medicare and adjust the Medicaid claim to reflect the primary payer processing; federal third-party liability statute and regulations require providers to identify third-party payers and refund their payment. If providers do not perform claim adjustments, the MSA will initiate claim voids. Hospitals are then allowed six months to bill Medicare for patients who obtain Medicare coverage retroactively. Members with questions should contact the MSA at (800) 292-2550 or Vickie Kunz at the MHA. 

Tags: MCO, Medicare, Medicaid, FFS, MSA, final policy

Posted in: Member News

MHA Updates Delivered to You

Subscribe to the MHA Monday Report weekly newsletter or our podcast, the MiCare Champion Cast, to keep informed about the latest healthcare news and events in Michigan.

MHA Monday Report
Contact us to subscribe

MiCare Champion Cast
iTunes | SoundCloud

Media Inquiries

Contact the MHA at
(517) 703-8601

Read the MHA policy on publication via MHA media.

MHA 100 Year Anniversary

Watch the video »