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Yes as MoE said, the "2 M's" all are run under each states specific rules. Medicare and Medicaid co-exist and cover different things.

NH have their own medical director who sees the residents and if needed puts in a consult request to other MD's, like a nephrologist, psych, etc. If the NH takes Medicare and Medicaid, the medical director takes them as payment.

The medical directors and other MD visits in the NH are being billed to Medicaid and Medicare Part B and also through any secondary insurance (Blue Cross) if the NH resident has that.

If you want to take them to another doctor, you can do that. BUT keep in mind that you will need to be the one actually doing that and paying for whatever their insurance doesn't pay. The NH staff won't do it because they have an MD on staff.

My mom, on Medicaid & in a NH, still see's her preNH opthalmologist. I take her for the 2 part visit every year. He does not take Medicaid or do any out-of-office calls (like to a AL or NH). He bills her Medicare and her Blue Cross. He does not see any patients who only have just Medicare. Patients have to have another billable policy/Medicare supplement policy in order to get an appointment. This seems to be really common among specialists. The reinbursement and paperwork is so that it isn't viable for most MD's to take just Medicare.

You should have a care plan meeting scheduled @ the NH so that your concerns regarding the doctors is discussed and explained. Most NH/LTC facilities have care plan meeting every 90 days for each resident but you can request one at any time.
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Occasionally, doctors don't take Medicaid, but in many cases the doctors who take Medicare also take Medicaid. As with many of these issues, much depends on the state where the person lives.
Carol
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