Health Care Reimbursement Obstacles

The insurance system — whether involving private policies or public programs like Medicare and Medicaid — is a double-edged sword for physicians and medical professionals. While it provides a means by which doctors can ensure a patient’s ability to pay before providing professional services, it also creates a labyrinthine bureaucratic process doctors and their staffs must navigate in order to receive payment. As a result, attending to reimbursement issues is consuming an ever-increasing percentage of the total work hours put in by both medical professionals and quasi-professional staffers.

Besides the obvious problem of the low reimbursement rates that Medicare and Medicaid provide, doctors who interact with these government insurance programs must be prepared to face numerous other challenges:

  • The wait times for reimbursement are typically longer.
  • The paperwork necessary to claim reimbursement is increasingly complex and time-consuming.
  • Medicaid and Medicare may deny coverage completely for certain services, leaving the doctor with the difficult task of seeking reimbursement directly from the patient after services have already been rendered.
  • Doctors must be particularly careful when making referrals of Medicaid and Medicare patients due to the Stark Law.

Unfortunately, increasing administrative demands reduce the time that physicians have to devote to the art of healing. However, with the number of Medicaid-insured patients likely to expand, doctors may find the problem unavoidable. Fortunately, consulting with a New Jersey health care law firm that understands the administrative requirements of the Medicare and Medicaid programs can provide medical professionals and their staffs with the knowledge and resources they need to interact more efficiently with government administrations and avoid the common compliance and reimbursement problems that their colleagues face.

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Posted in: Reimbursement