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Medical Billing Challenges for physicians accepting only Medicare and Medicaid

November 22, 2013

Medicare enrolment process is one of the main challenges faced by physicians. Due to various problems found in the enrolment process over past years, Medicare billing has become daunting for providers.

Increased paperwork and low reimbursement rates are also some of the hassles due to which many doctors are either opting out of Medicare or not accepting patients with this coverage. Previously, a single two-page form was used for enrolling but now there are six enrolment forms, making the process complicated for Medicare providers.

Providers also need to update their information periodically through revalidation process and keep reporting changes to their information. In case of out-of-date information, their billing privileges will be revoked.

Medicare providers cannot accept private pay and they can receive reimbursement only through Medicare. For this, they need to follow the accepted methods for collection and billing because any other arrangement will be a form of balance billing that will come under the category of Medicare fraud.

They can get paid for seeing Medicare patient only if they are “participating” (they will be paid by the government directly) or “non-participating” (they need to attend a patient over 65 but the payment will be made to the patient and provider will have to collect the fee). When it comes to approval of claims, Medicare is highly restrictive compared to private insurance carriers. With such low reimbursement rates, difficulty in claim approval and rising paperwork, medical billing companies has become a never-ending challenge for Medicare providers.

Challenges faced by Medicaid providers:

With the expansion of Medicaid, pressure of medical billing has increased for providers. From 2014, coverage will be expanded by Medicaid to 17 million Americans due to which physicians will have to attend increased number of patients.

Demand for time will increase for physicians who don’t want to attend new Medicaid patients but still want to continue in the program. There is no doubt that payment will be higher for physicians who attend more Medicaid patients but it will last only through 2014 which will not be sufficient for them.

There will be negative impact if practices don’t give proper training to the staff including clinicians, coders and billers and prepare them for Medicaid influx. Technology requirements will have to be fulfilled to manage the rise in documentation, claim filing and other activities.

Seeking assistance from a medical bbilling company :

Due to expanded patient load and difficulties related to Medicare and Medicaid billing, medical billing has become a daunting task for providers. Due to this, many practices are opting for assistance from a billing company.

Medical billing services offered by Medicalbillersandcoders.com have helped physicians manage their Medicaid and Medicare billing requirements. We have the largest consortium of billers and coders who are proficient in handling increased pressure of documentation, claim filing, ICD-10 requirements and adherence to HIPAA-5010. While our team is focusing on your billing requirements, you can concentrate on offering quality care to rising number of patients.


Category : Best Billing and Coding Practices