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

Policy & Regulation News

Medicaid Acceptance, Payment Rates Both on the Decline

By Jacqueline DiChiara

- The issue of a widespread lack of Medicaid acceptance is ongoing and yet to be resolved. A short-lived increase in Medicaid payments to primary care physicians last year has not generated an increase in Medicaid acceptance. More intervention is required for additional Medicaid acceptance.

The most common reason for an increase in Medicaid rejection is its trivial reimbursement rate. Medicaid pays only 61% of what Medicare pays for identical outpatient services, reports Kev Colemen, HealthPocket’s Head of Research and Data, in a recent study.

Thirty-four percent of healthcare providers currently accept Medicaid insurance, which compares to 2013 data for the same healthcare provider categories. This number is a 21 percent decline from two years ago.

Such data demonstrates that a temporary two-year increase in Medicaid payments to primary care physicians failed to generate long-term expansion for Medicaid acceptance. Medicaid payments represent a reduction on a reduction,” says Coleman.

“In the case of Medicaid, there is an overwhelming number of healthcare providers who do not accept the insurance which, in turn, undermines the value of the insurance provided,” says Coleman in an accompanying press release.

According to the researcher, health insurance is only as strong as the doctors who provide it.

“This year, the temporary increase in Medicaid payments to primary care physicians discontinues with only 15 states indicating that they intend to maintain the payment increase (fully or partially), “ Coleman maintains. “The reduction in Medicaid reimbursement to primary care physicians has brought with it a concern that Medicaid acceptance, already low among healthcare providers, will drop further.”

The Affordable Care Act (ACA) generated the most substantial middle class tax cut in the entire history of healthcare, allowing beneficiaries to more effectively manage their healthcare options, claims the Department of Health and Human Services. The ACA and the Patient Protection Program pushed many states to continually increase the eligibility range for Medicaid enrollment.

The ACA has indeed faced close scrutiny this month, as reported earlier this week, regarding upcoming King v. Burwell Supreme Court arguments to be presented in March. The legislation’s alleged shortcomings require review and discussion.

If the concluding King v. Burwell decision pleases petitioners, 9.3 million people could lose health insurance subsidies by 2016 with expected individual premium increases of 43 percent, reports Health Affairs.

“Many of the ACA’s key components [such as] the exchanges, the premium tax credits, the cost-sharing subsidies, and the individual and employer mandates—are complicated, confusing and disruptive [with] major flaws in the legislation’s basic design,” Senior Research Fellow in the Center for Health Policy Studies at the Heritage Foundation Edmund F. Haislmaier has argued.

In fiscal year 2013, the states and the federal government spent a combined total of $460 billion dollars for the Medicaid program, with 18 million more people likely to be receiving Medicaid coverage by 2018, according to HHS. Although there has been sizable growth in Medicaid enrollee expansion, only one in three healthcare providers accepts Medicaid, says Coleman.

Medicaid rejection rates continue to increase. In the immediate future, even more Medicaid beneficiaries will likely lose access to doctors, will need to wait several months to receive care, and will have to travel long distances to meet with a physician, federal investigators reported.



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