Proposed Changes to Medicaid could affect Coverage and Physician Reimbursement

by | Last updated Dec 8, 2023 | Published on Apr 10, 2017 | Healthcare News

Medicaid Affect Coverage
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Medicaid covers 74 million Americans and of the 20 million Americans who gained coverage under the Affordable Care Act (ACA), about half were through Medicaid expansion. With an in-depth understanding of the complex Medicaid system and its rules for various states, medical billing and coding companies help physicians create proper claims and bill correctly for patients covered under this government program. However, the Republican government’s proposed changes to funding Medicaid could have a significant impact on state spending, enrollment in the program, and physician reimbursement.

The Medicaid budget multiplied under Obamacare as more people got coverage. The Republicans believe that the federal government’s current spending on the program is unsustainable and put forward a bill to change this.

Medicaid reimbursement methods depend on a variety of factors which differ among states, though several criteria are fairly standard. According to recent report in The New York Times, the impact of the planned changes to Medicaid funding by the government could be greater than that caused by repealing Obamacare.

Under the proposed plan which was released on March 6, 2017:

  • There would be a strict ceiling or freeze on federal funding for every Medicaid beneficiary.
  • Different spending targets would be set for different types of Medicaid beneficiaries, like older Americans, blind and disabled people, children and adults.
  • Federal funding for Medicare would rise only with the medical care component of the Consumer Price Index, or the price of medical care.
  • These changes mean that funding will grow if more people enroll in Medicaid, but not if the cost of care for Medicaid patients increases, or if the states want to offer new benefits or increase payments to doctors.
  • In 2020, enrollment for expansion will freeze and states would have to pay more to enroll new members in Medicaid.
  • Legislators expect enrollees will drop out of the program as their incomes change.

Since its inception, the goal of the Medicaid program has been committed to improving healthcare for America’s most-poor individuals. Federal spending on Medicaid changes as states revise their policies, eligibility conditions, and payment rates for physicians, hospitals and nursing homes.

Experts think that the planned changes would reduce states ability to cater to the changing health care needs of their population unless they increase their own spending. Moreover, as medical inflation grows by 5-7 percent annually, the amount of money that states will be able to spend on Medicaid would decline, meaning cuts to eligible enrollees or eligible benefits.
The changes would go into effect only in 2020, and the long-term impact would vary among states, depending on their expenditure on the program, their demographics, and whether they expanded enrollment in Medicaid under Obamacare.

Regardless of the changes that come into effect now or in the future, medical billing expertise is crucial to ensure proper physician reimbursement. Medicaid claim forms and formats differ by state. Billing specialists in reliable medical billing companies can ensure claim submission the state’s specific format. They will also ensure that every claim is created with the correct information, such as the place of service, the National Provider Identifier (NPI), the procedures performed and the diagnoses listed, and the price of the procedures. They will also manage the complex task of medical eligibility verification and prior authorization. Such support is crucial for practices that choose to take in the challenges of accepting Medicaid patients.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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