Doctors and Medicaid

Google defines Medicaid as a service which provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. This in it-self sounds like a great idea, and it is, however implementation is challenging. Doctors who accept Medicaid have huge write off's because Medicaid doesn't always pay the same as other payers. Why is that? Lets take a deeper look.

You have probably heard of the affordable-care-act-expansion (ACA). This allows private companies to manage Medicaid claims at state level, almost like a private insurance provider. However this isn't working out so well. Its a bit broken according to Meratus Publications. In short, the main problem stems from broken processes with eligibility. Audits show states don't know who or why to pay. However there is hope.

If your doctor is a Medicaid health care provider, they may use a Medicaid website to submit claims. A claim is what a doctor submits to your insurance company so they can get paid. It shows the medical services that were provided to you. Typically, your doctor or provider, especially if they're in your plan, will submit the claim for you. It may not be enough to just submit using the website anymore. The claim may be rejected with no explanation. Submitting claims electronically through a medical billing software may be the answer your doctor needs to receive funds. Why does this make a difference? Even though ACA has been implemented in such a way that separates responsibility to private insurance companies, that electronic submission processes still works. You might be thinking, "Why doesn't the website work but electronic filing works?" This is because the "bridge" to submitting claims is so ridged. The bridge it-self hasn't changed except who is responsible for the claim. Funds are automatically dispensed without human contact. If your doctor's office doesn't get paid using electronic filing, they will receive an answer as to why it was not paid.

Electronic filing isn't foolproof. If there is fraud in your area, they may not pay anyone until the fraud is resolved. However you still get an answer as to why your doctor is not getting paid. Even when electronic claim filing does succeed in getting funded, the amount may be less. Some times the reimbursement is near 70% less than what was billed.

If your doctor has recently been struggling with getting payment from Medicaid, the ACA could be the cause. We may be able to help. Our practice management software is used in outsourced medical billing services as well as private practices with in-house billing. We have even assisted with re-filing late claims (timely filing). Want more information on how we can help? Contact us.

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