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DPM,MA
Medicaid NO longer paying copay nor deductible against Medicare in Texas

Here is the latest on the Lone Star state trying to balance it's budget.  It announced this in Nov'11, effective 1 Jan 12.  So, no telling how many patients we've seen since the 1st for nothing or next to nothing...  The Medicaid deductible is $160 against Medicare, by the way here.

This just came over the wire:

Medical Emergency: Act Now!

SOURCE:  http://www.texmed.org/Template.aspx?id=23932

Help preserve access to quality health care for dual-eligible patients and the physicians who care for them. "Dual-eligibles" are people old enough to qualify for Medicare as their health insurer and poor enough to qualify for Medicaid assistance. Hundreds of thousands of them live across Texas. Budget cuts and bureaucratic bungling threaten their care – and more. 

Read the rest of the story

IF YOU LIVE IN TEXAS, ARE FROM TEXAS, OR KNOW ANYONE IN TEXAS, PLEASE ENCOURAGE THEM TO SIGN THE PETITION ENCLOSED IN THIS LINK HERE. 

PHYSICIANS ARE ACTUALLY GOING UNDER OR ARE ABOUT TO BECAUSE OF THIS DEBACLE...  THE POWER OF THE PEN HAS LITERALLY PUT ENTIRE MEDI/MEDI REGIONS IN DIRE JEOPARDY- BOTH PATIENTS AND PROVIDERS, THAT IS. 

MANY PROVIDERS AND HEALTHCARE ENTITIES ARE DROPPING MEDICAID LIKE HOT POTATOES, WHILE OTHERS ARE TAKING THE $15 BUCKS OR SO ONE CAN GET OUT OF A VISIT.  DOING THE MINIMUM & STREETING THEM, BUT YA.  PATHETIC.

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And also this:

Medicaid to Clean Up Dual Eligible Mess

SOURCE:  http://www.texmed.org/Template.aspx?id=23931

State Medicaid officials say they will fix the mistakes and reprocess the claims of physicians incorrectly paid $0 for treating patients eligible for both Medicaid and Medicare, known as "dual eligibles." The Texas Medical Association brought the problem to their attention on behalf of physicians and their patients who were threatened with losing their health care because many physicians across the state faced financial ruin. 

Read the rest of the story

NO, THIS DOES NOT MEAN THAT WE'RE NOW GOING TO GET REIMBURSED FOR EVERYTHING WE DID NOT GET PAID FOR SINCE 1 JAN, ONLY THE ERRORS THAT WERE MADE IN THE STATE COMPUTERS, IN CROSS-OVER CLAIMS ON LINE ITEM 1, & WHEN HIPAA 5010 WAS NOT USED, ETC. (AS DELINEATED IN THE ARTICLE).

Just when you thought the grumbling in the Doctors' lounge couldn't hit any all time low(er)...

Are we the ONLY profession in which the pay has been steadily going down since about the time or before I decided to go into it (circa 1991)??  Happy daze are here again.  And I still love what I do, people.

Eternally optimistic, but as ever- may move to Guam one day and do this for local produce & cash, (afterall last I knew they had a VA, and it is a U.S. territory).

WG

MEMBER COMMENTS
Re: Medicaid NO longer paying copay nor deductible against Medicare in Texas

Here in NY - we don;t get the 20% medigap portion either. You refer to it as a co-pay, I think that terminology is incorrect as a co-pay can be any amount. If a patient has Medicare as a Primary and Medicaid as a secondary the 20% leftover is what we are talking about.

What I find interesting about this is the fact that one is obligated to collect the 20%. Anotherwords, if a patient has Medicare as a primary and no secondary - you charge the patient the 20% leftover, by LAW

So, how is it that the Gov't is able to break its own law? Meaning they state they won;t pay the 20%.

Here, In NY they pay 20% of the 20%. Now, I am not sure where they came up with that arbitrary number. THe obvious reason for cutting payment is that the state needs the money - but if this is the case then why should any state employee get a raise before the 20% reimbursement for doctors gets placed back?

Why is it that a doctor should do a service for free? Keep in mind - it is illegal to charge the patient for the money the state doesn;t pay you....these rules are absurd. At least - give us some type of tax credit.... 

Re: Medicaid NO longer paying copay nor deductible against Medicare in Texas

New Jersey adopted the same position a few years ago and it hurt BAD. Especiallyduring the "Deductible Season" of the first quarter of the year. We then got hit with the plethora of physicians who held onto the patients visit / procedure claims until April or May so that another doctor would have to bill the patient their share of the deductible and chase them for payment.

I agree with Jeff as to the Government breaking it's own laws sinc ethey are no longer going to pay the 20% nor the deductible. The kicker is when your not allowed to bill th epatient for this either.

We tried to get patient petitions going, but no one would sign it. The retired folks started to spread a rumor that went something like; "Don't sign anything against the government or they'll take your Medicare away", or many had the attitude of "So what - you doctors make too much money anyway - why do you need our signature". They certainly didn't see the big picture and the ramifications of such a law.

Amongst other things, this is one of the many reasons why I left private practice for full time V.A> employment - and I thank God for it every day.

There are less headaches (or better stated, different headaches), no more dealing with insurances / deductibles / co-pays / patients not paying - accounts receivable, etc. Now I have less worries of lawsuits, a steady income, benefits, I can focus in treating the PATIENT, and I have steady hours. Yes, in the big picture I'm making a bit less money - but I'm also not working as hard. The biggest hit was the loss of autonomy - but I'm learning to live with that.

Re: Medicaid NO longer paying copay nor deductible against Medicare in Texas

I have so many questions. Do states want to pay medicare's deductable for dual eligible medicare and medicaid residents? Was there ever any federal law or agreement to receive federal funding required states  to do so? These are questions that one should ask the federal government. If there is some agreement of each state with the federal government to pay the deductable is the state following any possible agreements it has with the federal government and if not why not? These are all questions I do not know the answer to. All I am doing is asking questions.

Daniel

Class 84