Should I “hold” my billing until the system changes are completed to avoid State recoupments of coinsurance overpayments?
Dear Medicaid Provider: This is to inform you that the Legislature enacted new legislation, effective July 1, 2003, that reduces the Medicaid payment for Medicare coinsurance for most Part B services provided to dual eligibles and Qualified Medicare Beneficiaries to 20% of the full coinsurance amount, in instances where the Medicare paid amount is higher than the Medicaid fee [Social Services Law, ยง367-a(1)(d)]. However, this new law requires Medicaid to continue to pay the full Medicare coinsurance amount for the services provided to Medicare Part B dual eligibles and Qualified Medicare Beneficiaries by ambulance providers, psychologists, clinics certified by the Office of Mental Retardation and Developmental Disabilities (Article 16), the Office of Mental Health (Article 31), the Office of Alcoholism and Substance Abuse Services (Article 32), and outpatient and freestanding clinics certified by the Department of Health (Article 28). The Medicaid program will also continue to pay the
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