“Thank You, Providers Who Accept Medicaid!” From: Me

During this holiday time of giving and family time, I would like to take a moment to say, “Thank you!” to all you health care providers who accept Medicaid. 

Thank you!!

It’s not easy to be a Medicaid provider, especially in our current Medicaid landscape.  It’s also not immensely profitable.  But, there are still approximately 70,000 of you in NC continue to accept and serve Medicaid recipients despite the rocky terrain.  And, I, for one, would like to say, “Thank you!”

More so than private insurances, and, I daresay even more than Medicare, accepting Medicaid patients places a large burden on the Medicaid providers. At least in Medicare, the reimbursement rates are higher.  Because the number one complaint I hear from health care providers is the Medicaid reimbursement rates SUCK! And they do!

For example, for CDT code D0120, which is a periodic oral exam, a dentist is reimbursed $25.27.  For a physician, an office visit emergency care is reimbursed at $18.20. Home health care medical supplies are also reimbursed at a law rate.  For 10 mL of sterile water Medicaid reimburses 41 cents.  (I didn’t realize that my computer does not have a symbols for “cents.”) An intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.) is reimbursed at $1.59.

My point is that, no matter what type of provider you are, a dentist, a physician, and a home health provider, if you accept Medicaid, you also have overhead costs (rent, electricity, perhaps cable), plus staff costs (salaries, taxes), plus other incidentals (office furniture, decoration, supplies) and you hope to make a profit.  Therefore, many health care providers simply do not accept Medicaid because the reimbursement rates are so much higher if they only accept private insurance, or even Medicare.

 Not to mention the federal and state regulations that you have to follow if you choose to accept Medicaid….Oh, and, by the way, if you fail to follow any regulation, you may be subject to an audit.

Oh, and, by the way, even if you DO follow all applicable rules and regulations, you are still subject to audits.

Instead of sending a Tentative Notice of Overpayment (TNO), a notice of an upcoming audit, some crappy reimbursements during this holiday season, I would like to send a big “Thank You!” to all the health care providers in NC that accept Medicaid.

Thank you!!

Posted on December 26, 2013, in Extrapolations, False Claims, Federal Law, Health Care Providers and Services, Medicaid, Medicaid Reimbursements, Medicaid Services, Medicare, Medicare and Medicaid Provider Audits, Medicare Reimbursement Rates, NC, North Carolina, Regulatory Audits, Tentative Notices of Overpayment and tagged , , , , , , , , , , , , . Bookmark the permalink. 4 Comments.

  1. Thank you for being a good professional for healthy interest of physicians and Heath care providers.

    V. Shukla MD

    Sent from my iPhone


  2. Thank you for your Blog Attorney Emanuel from a very small provider. I would like to know what do you think about the fairness of the 3% rate withholdings Jan 1st for PCS providers. We are suppose to earn the 3% back but they are going to withhold that amount without us providers knowing what the rules will be for the return of the money. I think it is obvious Medicaid officials want to run small providers out of business I think.

  3. Francine Kirkpatrick-Karuba

    , yeas, yea…..

  1. Pingback: Despite State Statute – Perhaps You Can Appeal Medicaid Prepayment Review! | medicaidlaw-nc

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