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088698 1 (1975-10-08)

handle is hein.gao/gaobactzy0001 and id is 1 raw text is: I ~ocial and Rehabilitation Service, R'egioni IT S 3').1tme nt of health, Fducation and elfare 7 25 Federal Plaza wYork 10007 Pear Tfr. >mith On August 1, 1975, we net with Messrs. :illil. Toby and Stanley A llen o' your staff to discuss Medicaid overbillIn's by the -elw York rity cal th and `ospitals Corporation (Hitc) for outpatient departmeat cLinvic services applicable to individuals; covered under both the Mecar and oMdi caid programs (dual. beneficiaries). This lotter , confirms theC information we supplied at that meeting. Outpatient hospital services are covered under palt a of icare, and assumingc the beneficiary has ret the annual 60 part 8 deductible, are subject to a 20 percent coinsurance provision which is the6 responi3bility of the beneficiary. The prodram eim- burses the instituion on the basis of 80 percent of reasonable costs, which are sunject to retroactive audit and adj stment, and the coinsurance portion is usually calculated and collected on the basis of 20 percent of the reasonable charges. For a dual bonefi- clary however, the cinsurence and deductible anounts are paid by ized icai;d. The Code of Pederal Regulations (CFR), Title 45, Parts 249.41(b) and (c)(2), 2 700'O0o)(3) (ii), and 250.31(b) taken to-;ether require, _n effect, that (1) all providers should bill Medicare first, then, (2) bill oicaid for the coinsurance aund deductibles not covered by m'dicare, and (3) the combined paynents from Medicare and Medicaid should not extceed what would have been paid by the program and the beneficiary under Medicare. loth the -ureau of liealth Insurance (831) P-roran )fficar, Reidbursiemnt 1Iranch, Peglon 1I, and a SRS Medical ervices Specialist have confirmed these requirements. So9497

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