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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 2: Texas Medicaid Fee-for-Service Reimbursement : 2.6 Medicare Crossover Claim Reimbursement

2.6 Medicare Crossover Claim Reimbursement
2.6.1
The payment of the Medicare Part A coinsurance and deductibles for Medicaid clients who are Medicare beneficiaries is based on the following:
If the Medicare payment amount equals or exceeds the Medicaid payment rate, Medicaid does not pay the Medicare Part A coinsurance/deductible on a Medicare crossover claim.
If the Medicare payment amount is less than the Medicaid payment rate, Medicaid pays the Medicare Part A coinsurance/deductible, but the amount of the payment is limited to the lesser of the coinsurance/deductible or the amount remaining after the Medicare payment amount is subtracted from the Medicaid payment rate.

Texas Medicaid & Healthcare Partnership
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