Does anyone have experience applying to accept Medicaid for healthcare biz?

November 18, 2024

by an intermediary from Northeastern University in Minneapolis, MN, USA

I am looking at a small healthcare services business. The owner has indicated that there is a large growth opportunity to drive volume via accepting Medicaid patients. Can someone provide a perspective as to whether they would consider this a tangible growth opportunity? Curious as to 1) how the application process is and 2) if accepted, do they squeeze you on price? Any help here would be greatly appreciated!

0 Likes

6 Replies

35 Views

Replies

Reply by a searcher
from University of Maryland at College Park in Havre De Grace, MD 21078, USA

^redacted‌ Depending on your billable codes and catchment area of patients, participating in Medicaid can make sense as part of your payer mix. The enrollment and compliance process is similar to other government payers (including Medicare). Medicaid is always one of the lowest payers, but can be helpful if used as a secondary in certain circumstances. Certain items can be billed to primary and the patient's share (copays, coinsurance, deductibles, etc...) may be covered by Medicaid as a secondary payor. ALL of this depends on the services billed and if they are even covered by Medicaid. Those eligible codes and allowable charges are published, so check it out. I might suggest talking to your billing department and seeing if they have experience in this payer and have them walk you through a sample of typical claims.

Reply by a searcher
from East Tennessee State University in Nashville, TN, USA

With Medicaid rates, it's like what your kindergarten teacher used to tell you....You get what you get, and you don't throw a fit! There is little to no negotiating room and a fair amount of regulatory burden, but the patient steerage is certainly there for the taking.

+4 more replies.

Join the discussion