Wiki Medicaid Reimbursement Health Choice

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AshleyCRPM

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We are from Arizona and an entity of Medicaid is called Health Choice. They take 30-45 days for reimbursement or more, and do not pay well. Our patients have to be seen every 30 days. My physician is frustrated to wait so long for payment when we have to keep seeing these patients so often and the claims are racking up while the Money is not coming in.

Is it ok to tell the patient they cannot have their next visit until their Medicaid pays for the last? We are one of the only pain management clinics that accepts this insurance in our county and other physicians have been dropping them like crazy because of the difficulties with reimbursements. I'm just concerned there may be some type of liability issue behind it. thoughts??:confused:
 
Been there done that with Medicaid Managed Care Plans. I would call the provider representative today and get them to come to your clinic and meet with the doctors to discuss this. When I managed a pediatric clinic in a similar circumstance as you describe, I contracted with two different Medicaid HMO's to pay us a monthly payment similar to a capitation agreement, but we still billed fee for service and applied those contracted allowables to the monthly payment. It was more bookkeeping, but the revenue stream was consistent, and we wound up seeing more patients and getting paid more promptly. It would not hurt to have your patients contact their plan and argue for your provider to get paid. In your case, you appear to be the "market" in pain management with lots of demand for very little suppliers.
 
Unfortunately my rep hasn't been able to help much. She begs us to stay because no other Pain physicians can deal with it. I hate to make the patients have to get involved but I think that's my only choice. If we drop them, any patients wanting to stay will have to pay cash and since its Medicaid It makes me wonder how many will actually do it. If they don't, they will have to drive 90 minutes to the next pain management that takes Medicaid. Decisions, Decisions...
 
Are you guys billing electronically? Setup to receive ERA and EFT from them? I never had that much of an issue and normally would be reimbursed before the 30 days when we used to bill Health Choice.
 
RE: Healthchoice

I am a biller in pediatrics and we deal with Healthchoice all the time. The standard payment cycle is 30-45 days for us as well and our claims are always sent electronically. Corrected claims thru paper can take even longer. Wish I had a magic answer for you.
 
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