04/29/2024

Billing QMB Patients As a Non-Par Medicaid Provider

I want to know if I do NOT have an individual medicaid provider number can I still see Medicare patients and collect the 20% coinsurance for the medicaid part (since I do not have a provider number)?

If you do not have a Medicaid provider number, you are still allowed to treat QMB/MQMB patients. However, whether you participate or not, you cannot bill any Medicaid patients for co-pays, co-insurance or deductibles if they have active coverage on the DOS. The only way that a patient is allowed to be billed is if a non-participating provider informs the patient that they do not accept Medicaid, and they agree to accept any bills for balances after processed by other insurance. This must be signed at every visit and is specific to the DOS- one agreement cannot be signed for all visits to the practice to collect any balances from the primary insurance.