A Medicare/Medicaid crossover claim submitted by a participating provider has what patient responsibility?

Prepare for the NHA Certified Billing and Coding Specialist (CBCS) Exam with engaging quizzes. Study with multiple choice questions, each offering hints and explanations, to enhance your understanding and readiness for the exam!

Multiple Choice

A Medicare/Medicaid crossover claim submitted by a participating provider has what patient responsibility?

Explanation:
Dual eligibility means Medicare is the primary payer and Medicaid is the secondary payer. When a crossover claim is submitted by a participating provider, Medicare pays its portion and Medicaid covers the remaining deductible and coinsurance. Since Medicaid steps in as the secondary payer and the provider has accepted Medicare assignment, there is no patient cost-sharing required. The patient’s responsibility is zero.

Dual eligibility means Medicare is the primary payer and Medicaid is the secondary payer. When a crossover claim is submitted by a participating provider, Medicare pays its portion and Medicaid covers the remaining deductible and coinsurance. Since Medicaid steps in as the secondary payer and the provider has accepted Medicare assignment, there is no patient cost-sharing required. The patient’s responsibility is zero.

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