Being a well-experienced medical practitioner, you can realize that it is very important to pay attention to the payments that you have to collect from government insurance companies. As a government program, Medicaid claims follow a unique set of rules. Therefore, practitioners should acquire innovative solutions to optimize their billing services.
In this regard, most of the successful healthcare organizations collaborate with most of the successful healthcare organizations that collaborate with Medicaid billing companies. In this way, they outsource their medical billing, coding, and revenue cycle management services to expert billing specialists.
Before diving deeper into the solutions for Medicaid billing services. Let’s understand some important terms about Medicaid, such:
Medicaid Has 2 General Types:
Medicaid is classified into 2 general categories
1. Community Medicaid:
It covers healthcare costs for those beneficiaries who have low income and they have very little medical coverage on their own.
2. Medicaid Nursing Home Coverage:
It covers medical care for those particular patients who receive nursing home services. Therefore, these beneficiaries are responsible to pay most of their income for the nursing homes.
Now let’s understand how patients can get funded by Medicaid.
Medicaid Administration:
The U.S Department of Health & Human Services (HHS) is responsible to administer the Medicaid Program. Each state in America has its own Medicaid program and they are individually responsible to implement it for the state’s beneficiaries.
Although, CMS has full control to develop the requirements for this program and keep the check on compliance with federal policies and procedures in every state. It is not inevitable to participate in the Medicaid Program though. However, every state participates in the Medicaid program, hence all of them are responsible to comply with regulations of federal policies.
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Federal regulations describe the minimum medical services that could be provided to the Medicaid beneficiaries. These services include inpatient hospital treatment, pregnancy and prenatal care and surgical dental services. However, individual states can also add medical services into their particular Medicaid program.
Now think of the busy schedule of your healthcare practice and also the complications that are involved in processing Medicaid claims. Medicaid billing companies can help you get insights into the legal requirements that’ll help you ensure compliance with federal policies.
Especially, when it comes to private HMOs that contract with the state Medicaid department and other insurance programs then the medical billing companies would cope up with the legal matters on your behalf. While you have to just pay complete attention to your patients and create strategies for further business growth.
Now you might be thinking why is it essential to particularly optimize Medicaid billing services?
Benefits Of Medicaid Billing Services:
The answer to this question is that the physicians should consider the Medicaid beneficiaries as an important source of income. Because the federal government and the states share the funding for Medicaid.
Hence, there is no way that you can miss out on the chance of collecting your money as there can be in the companies of the patients. Moreover, it is the state who is responsible to share the funds for Medicaid on the behalf of the government.
So if you have authorized your practice and qualifications then you’ll be able to promote your practice in your state. Hence, if you’d support Medicaid beneficiaries then you can engage the customer base on the state level. Some states also receive additional funding assistance from counties as well.
How To Verify The Eligibility For The Program?
Now you’ve understood that being a physician_ you can earn considerable revenue from Medicaid beneficiaries. Therefore, practitioners should pay close attention to Medicaid beneficiaries while delivering healthcare services. More importantly, they should first verify the insurance eligibility of the patient.
Now, it involves a lot of administrative procedures to verify the program eligibility of the patient and prepare medical billing claims to collect reimbursements for their services. Although, if you partner with Medicaid billing companies then they would handle all of the administrative responsibilities to maximize your revenue collection.
With reliable medical billing solutions, they will streamline your prior-authorization procedures. Also, advanced healthcare billing companies integrate practice management systems and offer EHR so you can easily record your patient’s healthcare information in cloud-based solutions.
With these solutions, they will easily verify whether the patient has qualified for the Medicaid Program and become eligible for the health coverage plan. So you can categorize those beneficiaries and collect your revenue from the right source.
For your information, I would like to mention that the Medicaid beneficiaries must also be eligible for another category of the CMS. There can be special expectations for those who receive medical care from nursing homes and disabled children who reside at their homes and get Durable medical equipment or such kind of remote healthcare services. For example, a child who has some sort of disability can qualify for the Medicaid program regardless of the eligibility of the parents or guidance.
Although, those individuals who meet the eligibility requirements of the program in terms of their medical conditions but don’t meet the income or asset requirement have a spend-down. These individuals can become eligible for the Medicaid program even if they pay their healthcare costs from their own pockets by using their own resources.
With these insights, you might have understood that it’s very complicated to dive into the excessive administrative workload while submitting medical billing claims. Therefore, you should adopt streamlined solutions such as relying on innovative Medicaid billing companies that have specialized solutions to optimize your revenue cycle management system and achieve the right extent of revenue growth.
Now how would you assess which agency is the best out of the many Medicaid billing companies in the healthcare marketplace?
Things To Look For Before Outsourcing Medicaid Billing Services:
When you specifically consider the administrative workload related to the revenue collection management for Medicaid programs then you need to consider the significance of the state’s Medicaid billing requirements.
More often, the CMS keeps introducing changes in the modifiers, medical codes, and qualification criteria in the Medicaid program. Therefore, every time a patient walks into the physician’s office, the medical practitioner has to reconsider the latest guidelines of CMS for their particular state
When billing for a Medicaid patient, you need to research the state’s Medicaid billing requirements. Some carriers want certain modifiers; others don’t. Verifying a patient’s eligibility status with Medicaid is usually difficult. Generally, you can only verify whether the patient has it and whether a referral is needed. The spend-down, if there is one, can’t be determined until after the claim has been submitted for consideration.
Many Medicaid policies are secondary to Medicare. If the patient has kept Medicare advised, the claim usually crosses directly from Medicare to be processed. Unlike other secondary payers, however, Medicaid usually pays per its fee schedule, regardless of what the primary payer pays.
For example, if a primary commercial insurance contract obligates a claim to pay $1,000, but the Medicaid fee schedule obligates the same procedure to pay $500, Medicaid pays $500, and the issue is closed.
