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Medicaid Pay Raise Delayed for Doctors But Will Be Retroactive to January 1–It’s the Complex IT Infrastructure & For

Posted Mar 15 2013 5:47pm

You can read through the article and like anything else out there today it needs an IT infrastructure built to execute sending the money out.  imageThere’s nothing new there and I think the consumer is now finally seeing what is happening on this frontier as you can’t speed it up if all is going at full speed.  Nice that the code is written to do a capture back to the first of the year though for sure.

Medicaid is a complicated formula done with matching federal funds and some states have made cuts in their programs.  This a a big increase to encourage doctors to see Medicaid patients which in every state is lower than Medicare and California is one of the lowest and anything is better than what is here now as doctors work hard to find doctors who will take a Medicaid referral patient too.  The only portion in California that pays well is pre-natal care as they want healthy babies, but the rest is so very low.  All the software has to be re-programmed to pay at the higher rates too so that’s just part of it.  A good question brought up in this article too is the managed care calculations, which is something new there to figure out too.  BD


A huge pay raise promised under the Affordable Care Act for primary care doctors who treat the nation’s poor covered by Medicaid health insurance is nearly three months behind schedule and may take another three months before it kicks in, state Medicaid directors say.

Under the health law, a primary care doctor – a family physician, a pediatrician or an internist – who treats a Medicaid patient will see their reimbursement rise to the level of the Medicare health insurance program for the elderly for scores of primary care services.  Doctors do have to apply to their state Medicaid programs and meet certain criteria in part proving that they have historically treated certain numbers of Medicaid patients.

The idea behind the pay increase, which is funded by federal dollars for two years, is to get more doctors to accept Medicaid patients and prevent other physicians from dropping out of a government program that hasn’t been well funded.  Amid a primary care doctor shortage, eligible patients will need all of the doctors they can get given the health law expands Medicaid coverage to millions more Americans effective Jan. 1, 2014 for participating states.

“How you do this in a managed care environment is the big challenge,”  Matt Solo, executive director of the National Association of Medicaid Directors said in an interview.  “It is not at all clear.”

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