Medicaid and Cash only clinics

Buprenorphine Post
Posts: 267

Postby peterorrin » Wed Oct 14, 2015 5:53 am

Like entjwb, I am an OPR Medicaid provider. Im not a contracted Medicaid Provider, but I can order, prescribe and refer...we filled out a form that allows that. The few Medicaid patients I do see pay cash at deeply discounted rates; also, they do not pay for their buprenorphine.

This epidemic is at least 5 years old, and the numbers are still going in the wrong direction...not well addressed! Changes in prescribing authority will occur soon (that's government-ese for within the year). To be fair, special interest groups behind the scene have vigorously opposed buprenorphine expansion. Do you know who they are?

My guess is that certified addiction docs will be authorized to expand numbers. Federally funded 'community health centers' will almost certainly be encouraged to have waivered docs on staff. Those clinics are well paid for treating Medicaid patients.

I intend to keep my present Medicaid status, but will start accepting Medicaid patients who pass our screen. By way, my current medicaid patients had commercial insurance once, but life reversals happened. I didn't do home visits either, but when patients got too old to come up my office ramp, I had to see them at home.

Posts: 4

Postby 767316 » Wed Oct 14, 2015 5:53 am

In Tennessee it is Medicaid fraud and a violation of the in network Provider's contract to accept cash for a Medicaid covered visit .
However , our administrative billing specialist says opioid dependence or addiction therapy as a stand alone diagnosis code in ICD9/10
is NOT a covered diagnosis code .

Posts: 104

Postby jmosby1469 » Wed Oct 14, 2015 5:53 am

Incidentally, here in Georgia, I give patients awaiting PA action two prescriptions: one for Medicaid, and a second one for a few days worth, with the discount card, to pay cash for as many as they want to hold them over. If cash poor, they then pick up as few as they need for a day or so.

Posts: 16

Postby tstinson » Wed Oct 14, 2015 5:53 am

In Massachusetts, charging a patient who is know to be on MassHealth (our name for Medicaid) is regarded as Medicaid fraud and is vigorously prosecuted.

Posts: 183

Postby MChaplin » Wed Oct 14, 2015 5:53 am

IN ct a patient can not use medicare to pay for scripts written by a non-medicare provider....the provider can write them- but the client will have to pay both the doc and the pharmacy out of pocket.

Posts: 4

Postby 767316 » Wed Oct 14, 2015 5:53 am

So , if the clinic doesn't file a claim or submit a claim for the visit to Medicaid (TennCare) , is it illegal to charge cash for the visit if
the Provider is a Medicaid (TennCare) Provider ?

Posts: 180

Postby entjwb » Wed Oct 14, 2015 5:53 am

In Ohio I am a OPR Medicaid provider. That means I can order, prescribe and refer but I don't charge Medicaid for my services. That allows the Medicaid enrollee to pay me cash for my services. I have found this has a positive effect for a motivation for the patient to wean off when that time comes. The programs that are federally and state funded and take their Medicaid has a problem getting the patient to be motivated to wean off. One other Dr. Takes Medicaid in outside practice so they don't see them for MAT.

Posts: 1404

Postby drpasser » Wed Oct 14, 2015 5:53 am

I agree with the above responses. It depends entirely as to whether or not one is a Medicaid provider. When in doubt, check with your liability carrier.


Posts: 1

Postby 222obgyn » Wed Oct 14, 2015 5:53 am

In Tennessee if one is a medicaid provider they are not allowed to collect cash for visit.There are few physicians who take medicaid as source of payment.There are many who are not in medicaid and charge the poor $300-400 office visit and then TnCare covers cost of medication.

Robert A Shearer MD

Posts: 118

Postby sslonim » Wed Oct 14, 2015 5:53 am

I think so but don't quote me ... possibly may vary by state. Here's an example I've seen (I live in Washington state). The Medicaid insurer I use requires pre-auth for Suboxone. So say a patient is out, I give them an Rx they take to pharmacy. Pharmacy lets us know a pre-auth is required before insurer will pay. You'd think the patient could pay cash for a day or 2 until the pre-auth comes in but NO - pharmacy is not allowed to take cash for a drug the insurer should/might pay for. If the pre-auth is denied then they can pay cash. (What's really "fun"=frustrating is when you know the pre-auth is going to be denied but I still need to do it so that the patient can pay cash after its denied.)

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