Can i bill a medicaid patient

In this situation, a provider must enter into a documented and written agreement with the member under which the member agrees to pay for items and services that are non-reimbursable under the medical assistance program C. Under these circumstances, a recipient is liable for the cost of such services and items. Questions regarding whether or not a service is covered by Health First Colorado may be referred to the Provider Services Call Center Providers shall not send overdue Health First Colorado member accounts to collection agencies, unless the billing is for a non-covered service and the member has reneged on a written payment agreement C.

Please note that Health First Colorado is the payor of last resort. If a provider who is not enrolled into the member's primary health coverage knowingly provides health services to a Medicaid member, neither the member nor Medicaid will be liable for the costs of services unless the member and the provider entered into a written agreement in which the member agrees to pay for items provided or services rendered that are outside of the network or plan protocols C.

Health First Colorado's policy on billing members for services is clearly articulated on pages of the Department's April Provider Bulletin B The American Academy of Family Physicians defines a Direct Primary Care Model DPC as an alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly or annual fee i.

Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high deductible wraparound policy to cover emergencies. As noted above, providers enrolled in Health First Colorado may collect only the established co-pay if applicable from Health First Colorado members for services covered by Health First Colorado.

Non-enrolled providers are prohibited from collecting any reimbursement for services covered by Health First Colorado. By definition, the majority of services offered under a DPC model are covered by Health First Colorado, but some practices may also offer non-covered services, e.

Providers may bill Health First Colorado members for non-covered services if the parties enter into a written agreement as described above. DPC practices may choose to offer a limited package of services, those not covered by Health First Colorado, to Health First Colorado members, for an agreed-upon fee.

Health First Colorado's Provider Relations Unit was developed to ensure that Health First Colorado has an adequate and comprehensive network of quality providers that meet high standards for physical, behavioral, dental and long-term services. Providers seeking additional information about this policy should contact:. We use cookies and other tracking technologies to improve your browsing experience on our site, show personalized content and targeted ads, analyze site traffic, and understand where our audiences come from.

To learn more or opt-out, read our Cookie Policy. A new study challenges the conventional wisdom on why many doctors refuse to take Medicaid patients. And this happens in large part because, for doctors and providers, billing Medicaid is a pain. Medicaid payment rates, the amount doctors receive for providing services, are on average lower than Medicare or private coverage.

This has typically been used to explain why many physicians are reluctant to take Medicaid and why some Medicaid recipients still struggle to access care. Access for Medicaid patients is a well-documented problem. Various surveys show providers are significantly less likely to accept Medicaid than Medicare or private coverage. That is on top of the other health challenges that people with lower incomes face.

Usually, as the authors reference, the access problem is seen as caused by the prices paid by Medicaid. But the problem goes deeper than that, according to this new analysis.

Not only does Medicaid pay out less, but doctors encountered more billing problems. About 19 percent of the initial claims submitted to Medicaid are not paid in full. For Medicare and for the private insurers, that share is much lower: 8 percent and 5 percent, respectively. The health care providers then must invest time and money to sort out any rejected or disputed claims.

And when you consider the disparity in the initial claims, with Medicaid already paying much less than Medicare or private insurance, these costs of incomplete payments eat up 16 percent of the value of a Medicaid visit for doctors, significantly more than the 7 percent for Medicare and 4 percent for private coverage. What is the cost of these administrative burdens? Fewer providers take Medicaid patients. The authors tackled the question from two angles, looking at individual physicians who move to a different state and therefore a different Medicaid program and at firms that operate physician offices in different states.

In both cases, they found an effect. A decrease in administrative costs — the CIP metric — was equally likely to lead to providers accepting Medicaid patients as an increase in reimbursement rates, by both measures. In other words, whether doctors were willing to take Medicaid patients depended as much on whether they faced administrative hurdles when trying to bill for their care as the actual price that Medicaid pays for the services they provide.

There are some limits to the study, which the authors acknowledge.