How Do Doctors Get Paid From Medicaid?
Medicaid is a state-operated health insurance program that is funded by both the state and federal government. Doctors must follow certain guidelines to receive payment for services from Medicaid.
Accepted Services
The service being billed to Medicaid must be covered under the patient's Medicaid plan for payment to be received. Doctors may contact their state's Medicaid office with a patient's Medicaid ID number to verify whether a specific service is covered or not.
Fee Schedule
Physicians must charge fees within a certain range for services to be covered by Medicaid. The Centers for Medicare and Medicaid services and each state's Medicaid office uses specific equations based off of a fee schedule to determine these rates.
Approved Provider
Accepting Medicaid payments requires becoming a Medicaid approved provider, which requires completing certain paperwork and meeting specific requirements that vary between states. Physicians must contact their state Medicaid office to obtain the necessary forms and procedures for becoming an approved Medicaid provider.
Claims
Physicians must submit a claim that includes a specific service code for each service provided, the patient's Medicaid number, a provider identification number and other specific information. The exact forms and procedures for submitting Medicaid forms vary among states.
Funding
The funding used to pay doctors through Medicaid is obtained through a combination of state and federal tax dollars.
