Health care providers refusing to bill Medicare, Medicaid?

Previous | Next
 rated by 0 users
Latest post Thu, May 21 2015 12:53 PM by ScottRIreland. 4 replies.
  • Thu, May 21 2015 10:47 AM

    Health care providers refusing to bill Medicare, Medicaid?

    I've run across this twice in the past couple of weeks. We've settled a couple of cases where the doctors never submitted the related bills to Medicare or other health insurance. They are submitting "unrelated" bills, but holding related bills until the personal injury case is settled. Is this going to be a common occurrence now?

  • Thu, May 21 2015 11:10 AM In reply to

    Re: Health care providers refusing to bill Medicare, Medicaid?

    Your question asks folks to predict the future (either with respect to your specific case or with respect to all personal injury cases in general -- I can't tell which).  Neither I nor anyone else who posts here regularly has that sort of ability.

  • Thu, May 21 2015 11:34 AM In reply to

    Re: Health care providers refusing to bill Medicare, Medicaid?

    ScottRIreland:

    I've run across this twice in the past couple of weeks. We've settled a couple of cases where the doctors never submitted the related bills to Medicare or other health insurance. They are submitting "unrelated" bills, but holding related bills until the personal injury case is settled. Is this going to be a common occurrence now?

    It has been a common occurrence for as far back as I can remember.

    Keep in mind that medical providers have a fee schedule for billing patients. When they bill medicare, medicaid or health insurance they are limited by law or contract as to how much they can bill for and have to waive the rest.

    If they bill the patient direct, they are not limited in how much they can bill so they hold the bills and retain a lien on the settlement for the full amount of the charges.

    You, as a personal injury attorney, should be familiar with the concept of negotiating a lien compromise with medical providers before accepting a personal injury settlement for your client.

    If you aren't familiar with that concept, let me know and I'll explain it to you.

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Thu, May 21 2015 11:38 AM In reply to

    • Drew
      Consumer
    • Top 10 Contributor
    • Joined on Thu, Mar 30 2000
    • PA
    • Posts 51,368

    Re: Health care providers refusing to bill Medicare, Medicaid?

    I would predict that Doctors have decent legal and financial advisors and they are most likely to follow the road that leads to higher reimbursement yields in the end run in a system where there are massive gaps between the so called retail bill and the actual reimbursement 

    .....that's not to say I haven't  met a few Mds who are penny wise pound foolish as to reimbursement procedures...including one married to a Harvard MBA.

    Sorry but my crystal ball is not of much help as to which road is likely to be the better road 



  • Thu, May 21 2015 12:53 PM In reply to

    Re: Health care providers refusing to bill Medicare, Medicai...

    What a warm welcome!  /sarcasm off

    I've been in practice 32 years.   I have never had it happen before. 

    I understand why it would make sense to the provider.  It just doesn't appear to have been a "common occurrence" in Idaho, north Idaho at least, until the past year or two.

     

Page 1 of 1 (5 items) | RSS

My Community

Community Membership New Users: Search Community