Optimizing Medical reimbursement for out-of-state providers.
The federal law pertaining to the creation of the Medical program, USC 42, recognizes the Medicaid beneficiaries sometimes receive healthcare services at facilities outside of their home states. This law, therefore, requires that Medicaid plan provide for the inclusion of out-of-state providers in their programs. The regulation promulgated to implement this law, 42 CFR section 341.52, states the Medicaid plans must provide a mechanism for paying out-of-state healthcare providers that treat the plan's beneficiaries. The law says that a state must "pay for services furnished in another state to the same extent that it would pay for services furnished within its boundaries..." However, many providers that render service to Medicaid patients from other states often do not receive the reimbursement they are entitled to because they do not carefully monitor this segment of their patient population. Healthcare providers can take steps to ensure they receive payment for the services they provide to out-of-state Medicaid patients. These steps include billing for such services properly, investigating additional sources of reimbursement, appealing reimbursement decisions, and participating in bordering states' Medicaid programs as contract providers.
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D002391:Catchment Area, Health; D017048:Health Care Costs; D007344:Insurance Claim Reporting; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence*; D013221:State Health Plans / Q000191:economics / Q000331:legislation & jurisprudence*; D014195:Travel; D014481:United States