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Thread: Does Medicare compensate doctors better than Medicaid does?

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    Does Medicare compensate doctors better than Medicaid does?

    Does Medicare compensate doctors better than Medicaid does?
    States pay substantial, (If not the major) portions of payments to Medicaid service providers, while Medicare is a federal program. Do differences of allowable rates induce doctors to accept Medicare, but not Medicaid patients? Do any members know the answer to this? Is Medicaid more acceptable by doctors in some states than others?
    Do any of this group's members actually know of this?

    Respectfully, Supposn

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    Re: Does Medicare compensate doctors better than Medicaid does?

    Quote Originally Posted by I'm Supposn View Post
    Does Medicare compensate doctors better than Medicaid does?
    States pay substantial, (If not the major) portions of payments to Medicaid service providers, while Medicare is a federal program. Do differences of allowable rates induce doctors to accept Medicare, but not Medicaid patients? Do any members know the answer to this? Is Medicaid more acceptable by doctors in some states than others?
    Do any of this group's members actually know of this?

    Respectfully, Supposn

    Yes. And the amount of less, varies


    "Medicare reimbursement refers to payments hospitals and doctors receive as a result of services provided to patients that are covered under Medicare. The reimbursement goes to the billing provider. Doctors can choose to accept the rate that Medicare has set for the services they have provided. Medicare pays 80 percent of these costs.

    Medicare is primary funded through payroll taxes collected through the Federal Insurance Contributions Act and the Self-Employment Contributions Act. The money is set aside from in a trust fund that the government uses to reimburse doctors, hospitals and private insurance companies. Additional funding for Medicare services comes from premiums, deductibles, coinsurance and copays.

    Medicaid reimbursement is similar to Medicare reimbursement in that the payment goes to the provider. However, doctors who chose to be Medicaid providers are required to accept the reimbursement provided by Medicaid as payment in full for the services provided. Certain groups are exempt from most out-of-pocket payments.

    Medicaid does not pay money to individuals, but operates in a program that sends payments to the health care providers. States make these payments based on a fee-for-service agreement or through prepayment arrangements such as health maintenance organizations. The state is than reimbursed for a share of their Medicaid expenditures from the Federal Government through the Federal medical Assistance Percentage, which is determined each year and depends on the State’s average per capita income level. While richer states receive a smaller share poorer states, the law requires the percentage to be between 50 percent and 83 percent."



    "Depending on the location, finding a doctor or specialist who accept Medicaid or Medicare may be difficult. In locations, where it is extremely difficult to find a practice that will accept the programs or if the nearest providers are a significant distance away, Medicaid and Medicare recipients may be allowed to visit any local doctor, who will be reimbursed for providing health services.

    Many doctors also have to deal with different rates when it comes to reimbursement of Medicare and Medicaid. According to a study from Forbes, Medicaid pays out an estimated 61 percent of what Medicare does nationally for outpatient physician services. This rate varies from state to state, but if the average is 61 percent, it is to believe that some areas are well under that mark.

    “Physicians interviewed in the study explained that they felt it was their duty to see some amount of Medicaid patients in their practice,” the article reads. “They recognized the moral need to provide care for this population. But they did not want to commit career suicide – they did not want good deeds to bankrupt their clinical practices.”


    Examining Differences Between Medicare, Medicaid Reimbursement




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    Re: Does Medicare compensate doctors better than Medicaid does?

    Quote Originally Posted by Gladiator View Post
    Yes. And the amount of less, varies


    "Medicare reimbursement refers to payments hospitals and doctors receive as a result of services provided to patients that are covered under Medicare. The reimbursement goes to the billing provider. Doctors can choose to accept the rate that Medicare has set for the services they have provided. Medicare pays 80 percent of these costs.

    Medicare is primary funded through payroll taxes collected through the Federal Insurance Contributions Act and the Self-Employment Contributions Act. The money is set aside from in a trust fund that the government uses to reimburse doctors, hospitals and private insurance companies. Additional funding for Medicare services comes from premiums, deductibles, coinsurance and copays.

    Medicaid reimbursement is similar to Medicare reimbursement in that the payment goes to the provider. However, doctors who chose to be Medicaid providers are required to accept the reimbursement provided by Medicaid as payment in full for the services provided. Certain groups are exempt from most out-of-pocket payments.

    Medicaid does not pay money to individuals, but operates in a program that sends payments to the health care providers. States make these payments based on a fee-for-service agreement or through prepayment arrangements such as health maintenance organizations. The state is than reimbursed for a share of their Medicaid expenditures from the Federal Government through the Federal medical Assistance Percentage, which is determined each year and depends on the State’s average per capita income level. While richer states receive a smaller share poorer states, the law requires the percentage to be between 50 percent and 83 percent."



    "Depending on the location, finding a doctor or specialist who accept Medicaid or Medicare may be difficult. In locations, where it is extremely difficult to find a practice that will accept the programs or if the nearest providers are a significant distance away, Medicaid and Medicare recipients may be allowed to visit any local doctor, who will be reimbursed for providing health services.

    Many doctors also have to deal with different rates when it comes to reimbursement of Medicare and Medicaid. According to a study from Forbes, Medicaid pays out an estimated 61 percent of what Medicare does nationally for outpatient physician services. This rate varies from state to state, but if the average is 61 percent, it is to believe that some areas are well under that mark.

    “Physicians interviewed in the study explained that they felt it was their duty to see some amount of Medicaid patients in their practice,” the article reads. “They recognized the moral need to provide care for this population. But they did not want to commit career suicide – they did not want good deeds to bankrupt their clinical practices.”


    Examining Differences Between Medicare, Medicaid Reimbursement




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    This.

    In addition.. there are often more hoops set in the way for Medicaid reimbursement.. so that the provider has more administrative costs, and hassles in an effort to even get paid.

    At one time.. before Obamacare.. in a couple of states we have facilities.. it was better to treat Medicaid patients for free.. rather than actually bill Medicaid.. because it would cost us more to bill.. than to actually get paid.

    And.. if we were listed as Medicaid providers.. we would be committing as they said here.. business suicide.
    Last edited by jaeger19; 07-09-19 at 02:54 PM.
    So we should put you down as supporting putting GPS trackers in everyone to "save lives"?
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    Re: Does Medicare compensate doctors better than Medicaid does?

    Quote Originally Posted by I'm Supposn View Post
    Does Medicare compensate doctors better than Medicaid does?
    Yes: Medicaid-to-Medicare Fee Index.

    The story for hospital reimbursement is a little different: Medicaid Hospital Payment: A Comparison across States and to Medicare.

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