Learn more about this event

Medicaid billing often feels like navigating a maze: complex, state-specific, and ever-changing. This webinar will demystify the process by breaking down Medicaid’s structure, from federal “floor” requirements to state-level variations in coverage, eligibility, and documentation rules. Attendees will gain insight into the critical differences between fee-for-service and managed care, as well as how managed care organizations (MCOs) add layers of requirements such as prior authorizations, network rules, and timely filing limitations.

We’ll also explore Medicaid’s role in supporting population health through IHS, FQHCs, and Rural Health Clinics, where billing and reimbursement methodologies differ significantly from traditional fee-for-service. Participants will learn how quality programs like EPSDT, HEDIS, and Medicaid Stars connect directly to coding and billing accuracy, ensuring providers receive credit for services delivered. Real-world case studies will illustrate common pitfalls and strategies to prevent denials, enhance compliance, and align billing with Medicaid’s evolving requirements.

Learning Objectives/Agenda

• Distinguish between federal Medicaid rules and state-specific coverage variations
• Explain how managed care organizations (MCOs) mirror and modify state Medicaid requirements
• Recognize common Medicaid billing errors and denials, and identify strategies to prevent them
• Understand the unique billing methodologies for IHS, FQHCs, and Rural Health Clinics
• Connect EPSDT, HEDIS, and Medicaid Stars measures to documentation and coding accuracy
• Apply practical workflows for eligibility checks, prior authorizations, and timely filing
• Locate reliable resources for staying up to date with Medicaid policies and payer changes

Why is this topic important?

Medicaid enrollment has grown to cover over 85 million Americans in 2025, making it a dominant payer across the healthcare landscape. With increasing use of managed care and evolving population health initiatives, billing teams face more complexity and risk than ever. Federal audits, state policy shifts, and quality-based incentives tied to HEDIS and EPSDT make it essential for coders, billers, and compliance professionals to master Medicaid’s coverage rules. Timely and accurate Medicaid billing not only protects revenue but also supports broader goals of access, quality, and equity in healthcare.

Who would benefit from this topic?

• Medical Coders
• Medical Billers
• Practice Managers
• Compliance Officers
• Revenue Cycle Managers
• FQHC, RHC
• IHS administrative staff

What is the presenter's background/expertise on this topic?

Ms. Turner has extensive experience in revenue cycle management, compliance, and coding education across physician practices, FQHCs, hospitals, and telehealth organizations. She has worked with many levels of Medicaid with many states, as well as contributing in litigation in Medicaid compliance and reimbursement strategies. Ms. Turner has also worked directly with many cases involving Medicaid programs in multiple states, helping providers navigate complex coverage rules, reduce denials, and align documentation with compliance standards. She specializes in bridging the gap between regulations and practical workflows, making her a sought-after speaker and consultant on Medicaid billing.

You rated this event: