The choice to accept Medicare and Medicaid can substantially expand a hospital or medical practice’s patient base. Agreeing to certain terms so that a company can accept government insurance reimbursement may cut into their profit margins for certain types of care but can also create more overall revenue for the practice.
There has been an effort to scale back government insurance following an expansion of coverage a few years ago. The intentional reduction of beneficiaries in Texas resulted in approximately 1.7 million people losing Medicaid coverage. Many of those people lost their coverage not due to ineligibility but instead procedural errors, like failing to send in documentation to renew.
What impact could that decrease in Medicaid recipients have on healthcare providers?
Some invoices may not be eligible for payment
Patients may not always know that they are no longer eligible for Medicaid benefits. Even if they do know, they might choose not to disclose that detail when seeking medical care. Unfortunately, healthcare providers could find themselves with invoices that are not eligible for reimbursement through the Texas Medicaid program.
They may need to explore to hold individual patients accountable for services not covered by Medicaid. Reviewing the situation with staff could also be beneficial. Otherwise, those in the billing department might engage in creative billing practices in an attempt to recoup those losses.
The intentional manipulation of invoices sent to Medicaid could lead to fraud allegations and also an inability for a facility to accept Medicaid coverage in the future. Recognizing how policy could impact business practices may help those managing or working at modern healthcare facilities avoid potentially major errors.