One of the most frustrating calls a front desk gets is a caller who asks if the office takes medicaid. Sadly, the answer is usually no, the office doesn’t take Medicaid.
When medicaid was first expanded, it was touted as having lots of doctors for the newly insured. Only one small problem with that, as newly insured medicaid people found out the hard way many years ago. While the paperwork SAID that certain doctors took the medicaid, the harsh truth soon emerged. The doctors in most cases WERE NOT taking medicaid patients whatsoever……when the program first came after being expanded, the hopes of the people printing out the flyers saying more doctors….got the rudest wake up call ever. They soon discovered that doctors all over the country HATED medicaid with a passion. So the thought of having more doctors taking medicaid went over like a lead balloon with many of the doctors.
More and more doctors however, are no longer accepting medicaid patients. The notice on the clinic’s website, “We do not accept Medicaid,” might as well say, “Poor people aren’t welcome here.” It’s an unfortunate practice that is sadly all too common and affects the lives of millions of Americans.
A study showed that almost 47 percent of physicians nationwide were not willing to accept new Medicaid patients. The rate was even higher for a dermatologist or an orthopedic surgeon, two of the highest-paying specialties in medicine. The Affordable Care Act led to some modest improvements, particularly in general primary care, but the acceptance rate of patients covered by Medicaid remains dismally low. Patients with Medicaid are also requiring more attention and resources than the average patient. So the job satisfaction argument goes like this: To minimize encounters with difficult patients, prioritize those with private insurance and turn away those with Medicaid.
I’ve worked in offices where the doctor or doctors I worked for were the ONLY medicaid provider with in 200 miles or the only one for several counties in the surrounding area( especially with specialty doctors) The doctor that takes medicaid is shrinking more and more each and every passing day.
Why? Simple, it’s the insurance that pays the lowest amount on a claim, and it’s simply not cost effective for the office. The office will have to literally write off the rest of the cost of the claim when the low reimbursement comes in. To explain why some physicians do not accept Medicaid patients, physicians and administrators frequently blame the bureaucratic hassles of Medicaid, particularly its subpar reimbursements.
Ok, let me give you an example. A procedure costs $1000. How much does medicaid pay? Less than $200 in most cases! I can see eyebrows going up. So what happens to the rest of the bill? I can hear you asking. It can be sent on to the patient right? NOPE! Per medicaid rules across the country, the difference can’t be passed on to the patient. Doctor’s offices have to write off the balances. Shocked? Most people are.
Here’s some more sobering facts about medicaid that can maybe help explain a bit better why most doctors don’t take many medicaid patients……
There are TONS of regulations. Since all states have their own medicaid rules and regulations, that’s 50 different kinds of hoops to jump through and some states are way more strict than others. Each state does medicaid differently.
Medicaid only pays 61% of what MEDICARE pays nationally. Yes, 61%of what medicare pays. Not a lot huh? When I saw that number, I wasn’t actually all that surprised. I’ve done lots of medicaid claims over the years y’all. Seeing that low number did not surprise me unfortunately.
Unacceptable wait times for getting reimbursement. The average wait time to get reimbursed from medicaid? 44 days. Other insurances like Aetna, Humana, Blue Cross or United Healthcare would only take 26 days for reimbursement on average.
Complex paperwork. Sometimes medicaid paperwork would be like 20 pages, if I was lucky. Some state medicaid has more paper work than others. And all 50 states are different in terms of medicaid paperwork. There is no common form among the 50 states for medicaid paperwork whatsoever.
In the age of “everything is going electronic”…. 42% of medicaid paperwork still has to be mailed in before you get the green light to proceed. Not email, not fax it over………you have to do it snail mail for medicaid paperwork. And it takes forever for it to get processed once medicaid does get the paperwork.
Medicaid has a higher denial rate for claims to go through than other insurances. Medicaid has 18.5% denial rate. The other insurance payers on average only have 6.8% denial rates.
Only 45.7% of doctors across the country are willing to take new medicaid patients! That’s a very low number wouldn’t you say? When I first saw that percentage, I was a bit shocked. I honestly thought the number would have been higher myself.
The fees are frankly too low to induce doctors to participate. I remember working for a brand new doctor a few years ago who was just joining the practice, who once he saw the low fees, literally turned up his nose and said nope, not doing medicaid.
Many doctors do not want to commit career suicide by just seeing medicaid patients. Many people keep forgetting doctors are self employed, with overhead and staff to pay. When it comes to late reimbursements and long approval times to get the green light, it costs money to the doctor, sometimes with disastrous result. I have seen many office people have to be laid off over the years because the money reimbursements for medicaid just weren’t coming in fast enough to help cover expenses when medicaid patients were the majority of the patients that the doctor’s office saw.
Less money + late reimbursements do not equal happiness from the doctor. Don’t even get me started on this one. I’ve seen more swear words coming from the doctors from my vantage point of the back office when I had to tell them I was still waiting for medicaid reimbursements to come in. That does not make for happy doctors.
Patients on medicaid require more time and attention than the average patient. When I helped schedule patients, I knew which patients to schedule longer times for. Granted, new patients got longer times too because the doctor needed to get to know the new patient, however, once that was done, if it was a medicaid, the doctor would flag to alert us in the office that this patient needed more time scheduled so they could go over everything the next time the patient came in
Many doctors felt that social and behavioral needs required a disproportionate share of time from them and their staff. In a couple of offices I’ve worked in, I literally had to put signs up saying “Swearing at the staff will not get you faster help. Please be polite to the staff.” People can laugh all they want, I don’t care. The signs did help those offices once I put the signs up. And believe me, the doctors do ask the front desk how the patient treated them, because if it gets out of hand, the doctor will fire the patient without batting an eye.
Many doctors across the country don’t want to be the bad guys when it comes to taking medicaid. There are many doctors across the country with large hearts who would love to take on more medicaid patients………if they could. The have to consider resources, if the patient is even going to follow medical advice…etc. With transparency low from medicaid themselves, that doesn’t exactly give doctors warm fuzzies , ya know?
Medical Coding Mama 