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Medicare/Medicaid Crossover Accounts: Are They At Risk?

Medicare recently published updated bad debt regulations and the time is NOW to safeguard your Hospital’s reimbursement. Are you following proper guidelines to ensure you can write-off your Medicare/Medicaid crossover accounts?

The first step to ensure you are following proper guidelines is to review the “Must-Bill policy” for reimbursement of crossover bad debts below.

  • The easiest way to cover yourself is to ALWAYS bill the patient’s Medicaid plan(s). Make sure the Medicaid insurer provides you with a remittance advice. After you receive the paid remittance advice, you can safely write off your account as a Medicare/Medicaid crossover.
  • Medicare claims that are recouped and reissued DO NOT automatically crossover to Medicaid. It is the provider’s responsibility to re-bill Medicaid after the Medicare reissue. This will result in receiving another Medicaid remittance advice. This procedure is often reviewed during MAC audits.
  • In some circumstances, providers can comply with the “must-bill” policy for crossover accounts when a State does issue a Medicaid RA to providers.
    • Alternative documentation to the Medicaid remittance advice would include (A) the State Medicaid notification indicating that the State has no obligation to pay the beneficiary’s Medicare cost sharing or notification indicating the provider’s inability to enroll in Medicaid for purposes of processing a crossover cost sharing claim, (B) documentation setting forth the State’s liability, or lack thereof, for the Medicare cost sharing, and (C) documentation verifying the beneficiary’s eligibility for Medicaid for the date of service.

Key Question to Ask Your Team to Ensure Maximum Reimbursement: 

  • Are you billing Medicaid timely for accounts that are Medicare/Medicaid accounts?
  • Are you re-billing Medicaid for accounts that Medicare recouped and reissued remittances?
  • Do any of your Medicaid insurers fail to provide remittance advices for no coverage?
  • Are you keeping proper documentation to show there is no liability for the patient?
  • Are your billers up-to-date with the “Must-Bill” policy for Medicare/Medicaid accounts?

To safeguard and maximize your Medicare bad debt reimbursement or for more information, please contact your local Blue & Co. advisor.

Full CMS rulings:

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