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Medicare and Medicaid reimbursement issues

On Behalf of | Apr 7, 2023 | Blog, Health Care |

Medicaid enrollment increased from 2018 to 2019 by nearly three percent, and in 2022, Medicaid provided services for 89 million people while Medicare serviced 65,103,807 people.

Some of the most vulnerable individuals in the US population, including millions of children, rely on Medicaid and Medicare to pay for healthcare services. Although medical professionals want to provide medical care to those who need it, they may run into a few reimbursement challenges.

Compensation amount

One of the most significant issues medical providers face when they work with Medicaid and Medicare is the cost of care versus the amount of reimbursement. In fact, in 2020, the federal and state government underpaid medical providers by $75.6 billion. Unfortunately, many providers do not receive enough to cover their service costs because these insurance providers only pay 84 cents on every dollar, and they do not adjust enough for inflation, increasing the shortages.

Telehealth services

Today’s medical customers increasingly seek telehealth services. These services are especially valuable for those who live in rural areas and those who find it difficult to get to their appointments. However, Medicare and Medicaid site overuse, fraud, care quality and overpayment potential as reasons to avoid or reduce payments. Fortunately, the Consolidated Appropriations Act of 2023 extended telehealth payments for an additional two years.

Increasing denials

Although technology revolutionized healthcare services, payment software was not as beneficial. In fact, payers use software that results in increasingly more denials, and healthcare providers do not have the time to rework and resubmit these bills. In addition, health insurance companies, including Medicare and Medicaid, are for-profit organizations, so they receive incentives if they reduce their payouts.

Medical professionals should investigate all the relevant issues and develop strategies to address them to gain the best Medicare and Medicaid reimbursement results.