Report: Medicaid patients in the United States are on different fee-for-service rates

Jan 13, 2014 | Health Insurance Billing

Paying for health care services can be costly, but the rate is not the same across the board. Health insurance providers offer different co-pays, flexibility in visiting doctors as well as different costs for each procedure. On the other hand, Americans who utilize the government's Medicaid program may think that the price and coverage is the same across the board.

According to data found from the Government Accountability Office (GAO), that is not quite the case.

Every day, accounts receivable teams spend the bulk of their time communicating with health insurance, Medicare and Medicaid providers, asking them how much is it going to a cost a patient for treatment. While Medicaid rates within a state may be consistent, one patient in Iowa could be paying more or less than another in Pennsylvania — even if they are both Medicaid subscribers.

The GAO examined data from 35 different services like pathology, maternity and imaging and found that the prices differed from one to another. Although the GAO's sample size was based on information in nine states, it is worth noting how much Medicaid disbursements are going to practices for the same exact treatment options.

"Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail: provider type, service setting, and/or patient age," GAO's announcement on the findings explained. "Some states also varied their payment rates for other reasons, such as by geographic region or by physician specialty."

This may pose to be a larger problem for medical accounts receivable because the Affordable Care Act expanded Medicaid eligibility. Now, households with an income of $29,700 can enroll in this system. If the prices continue to be in limbo on a variety of factors, this can cause confusion in the department, as well as the patients who are responsible for these payments. 

In order to make the most out each account, practices can benefit from Professional Medical Services to get rid of backlog of unpaid medical bills.