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Capping Medicare and Medicaid Patients

In an effort to ease some of the medical profession’s trepidation concerning the Affordable Care Act (ACA), many proponents have pointed out that it is likely to bring a new influx of patients with a guaranteed ability to pay, thereby increasing revenues for health care providers. These commentators fail to appreciate, however, that more is not always better, especially for small practices already stretched to their limits.

Even prior to the ACA and Medicaid expansion, many doctors simply refused to take Medicaid and Medicare patients. Others limited the number of such patients they would carry at any given time. Their reasoning is simple: while these programs do ensure the patient’s ability to pay for services, treating patients who participate in these programs often requires doctors and their staffs to do much more work and ultimately receive much less compensation:

  • The paperwork burden for dealing with Medicare and Medicaid is much more onerous than that of private insurance.
  • Medicaid often reimburses a fraction of what private insurance would for the same service.
  • Medicaid patients have often gone many years without seeing a doctor. Others may have generally poorer health due to occupational, environmental and lifestyle issues. As a result, attending to Medicaid patients can require a disproportionate amount of time and effort.

The continuation of Medicaid-Medicare parity for 2015 may provide health care providers with a greater incentive to work with these patients. However, many practices may find that it is not financially feasible to accept Medicaid without limitation. Health care providers who are considering adopting policies or limitations regarding Medicare and Medicaid patients should consult with an established New Jersey health care law attorney to gain legal perspective on the matter.

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  • Posted on: Sep 12 2014