Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Can Increased Medicaid Reimbursements Improve Appointment Availability?

By Stephanie Reardon

Study determined Medicaid appointment availability directly correlated to the size of the Medicaid reimbursement increase implemented by the ACA.

- The Affordable Care Act (ACA) allows many previously uninsured individuals to get affordable healthcare. In order to help these beneficiaries receive primary care, the ACA had Medicaid agencies in every state increase Medicaid reimbursement rates during 2013 and 2014. The amount of the increase in Medicaid rates varied from State to State, but it was instituted to ensure physicians would not turn away Medicaid patients or limit appointment availability for fear of low reimbursement returns.

A study published by The New England Journal of Medicine determined that Medicaid appointment availability directly correlated to the size of the Medicaid reimbursement increase implemented by the ACA.

The study involved primary care offices in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas.

To gather information, staff members pretended to be patients seeking a new-patient appointment and called randomly-selected offices during two different time frames. The two different time frames were November 2012 through March 2013 and from May 2014 through July 2014.

The results of the study showed that although private-insurance appointment availability stayed at 86 percent during both time frames; Medicaid appointment availability increased from 58.7 percent to 66.4 percent.

In addition, the study showed that the states with higher increases in Medicaid appointment availability were also usually states with higher Medicaid reimbursement increases. The states with this correlation were: New Jersey, Pennsylvania, Illinois, and Texas. Montana was an exception to this conclusion because it had one of the smallest increases in Medicaid reimbursement out of the 10 states, but the result of the survey still indicated a 6.8 percent increase in its available Medicaid appointments.

“Provider access is of particular concern for the Medicaid program, which is set to absorb the bulk of newly insured persons in many states, because Medicaid typically reimburses providers at much lower payment rates than those of Medicare and commercial insurers for the same services,” the study states. “Lower payments have been cited as a critical barrier to access for primary care among Medicaid enrollees and are associated with lower provider availability for Medicaid patients.”

This federally mandated increase in Medicaid reimbursements ended on January 1, 2015, and according to another report on, reimbursement rates for providers who accept Medicaid patients in some states might drop by 50 percent. Although this mandate has not been extended, providers are considering legal action in an attempt to increase Medicaid reimbursement rates.

The US Supreme Court is currently reviewing a case with the aim of overturning a 2011 court ruling that increased Medicaid payments to physicians who gave care to Medicaid beneficiaries with disabilities. Idaho State officials argue that the state should dictate provider fees, and that the rates should not be controlled by physicians using the legal system to get higher pay. The final ruling on this case may have a heavy impact on healthcare providers hoping to keep Medicaid payments at a reasonable level.



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