Win More Medicaid Clients & Effortlessly Manage Claims

Are you struggling to get into Medicaid—or get your claims through the first time? Read on to get these questions answered and more. 

In this article, we’ll talk about: 

• What are Medicaid and Medicaid Waiver programs?
• What are common objections to providing Medicaid services?
• What are the reasons to have Medicaid in your home care agency?
• Four most common reasons for Medicaid claim denial

What are Medicaid and Medicaid Waiver programs?

Medicaid is a federal-state program that provides health coverage to qualifying low-income individuals. Those include: 

• Adults
• Children
• Pregnant women
• Elderly
• People living with disabilities

Medicaid enables members to stay at home by covering services through Medicaid Waiver programs (or Home and Community-Based Services Waivers). These programs allow states to create specific programs for particular groups, like the elderly or disabled. 

This allows Medicaid to expand coverage to services (that typically aren’t covered by Medicaid) like personal care assistance (where your caregivers come in) or home modifications. 

WATCH THE RECORDING: Win More Medicaid Clients & Effortlessly Manage Claims

What are common objections to providing Medicaid services?

According to Medicaid.gov, there are over 7.2 Million older adults who receive Medicaid assistance at the same time they’re receiving Medicare benefits (also known as dual eligible). Despite that large pool of potential clients, what’s keeping agencies out of Medicaid? 

There are quite a few reasons, including:

1. Low reimbursement rates: Medicaid determines the reimbursement rates, which don’t compare to the rates that you might charge on a private pay basis. This also makes it financially challenging for agencies to cover costs while remaining profitable. 
2. Administrative work: Dealing with Medicaid is complex, and involves paperwork, regulations, and oftentimes, delayed payments. When it’s time-consuming and costly, it makes it hard for agencies to continually look for Medicaid clients.
3. Limited service coverage: Medicaid may not cover all of the services that a client needs or allot for the amount of hours for a client to get all of the care they need. 

Now that the 80/20 rule is a looming reality for agencies, “It is so imperative for your agency to run a lean operation, to have processes and workflows in place, as well as technology that will help support you in growing your client base,” shared Maria Wolbert, Senior Account Executive at CareTime. 

With the reimbursement climate we’re in now, you have to grow faster than the pace of reimbursement increases. By setting your agency up with the operational tools you need, like the right agency management system, you can equip your team to support your revenue goals.

With that out of the way, let’s talk about reasons why you should add Medicaid to your agency if you haven’t already. 

READ MORE: Fast Track To 1 Million Your First Year In Business 

[By Leveraging Your HomeCare Software]

Why your agency should add Medicaid to your payer mix

Despite the challenges we just talked about, there are quite a few reasons why your agency should add Medicaid to your payer mix. 

10,000 older adults are turning 65 every day, and with more than 10 Million children and adults living with disabilities relying on Medicaid for support, the demand for high-quality care has never been higher. 

In fact, there is a shortage of Medicaid providers to adequately meet the needs of care recipients. Approval for HCBS waivers can take up to 3 years, with more providers able to serve clients, this issue can be shored up. 

1. Consistent client base: Medicaid provides you and your team with a steady stream of clients from underserved communities, which can be especially helpful for a new agency to establish itself and grow census. Growing your census doesn’t just mean clients alone; this means having the runway to keep caregivers coming in the pipeline and retained over time. 
2. Community impact: You probably came into this business from a personal experience with care or to make a difference in the lives of others in a meaningful way. 
3. Growth potential: Once you’ve learned how to serve one Medicaid client, you know (from an administrative standpoint) how to handle the next. 

“With low reimbursement rates, you want to service as many clients as you can without simultaneously increasing your administrative headcount. We can help you do this with technology. By setting up workflows to ensure that you can service these individuals and provide high-quality care without being overwhelmed by administrative tasks and managing data,” Wolbert added. 

The administrative aspect, is probably one of the most important things to talk about here. Medicaid is likely the top administrative challenge your team will have. 

If you can serve them from intake to reimbursement, this can ease the management of Long-Term Care Insurance, VA, and Managed Care if you haven’t already tried these payers. 

READ MORE: Why 2024 Is The Year To Diversify Your Home Care Payer Sources

The four most common reasons for Medicaid claim denial

If you already accept Medicaid clients, you might notice various reasons for denial. Here are the most common ones we’ve seen with our customers. 

1. Missing or incomplete information: This usually means missing client details like their name, date of birth, or Medicaid ID. Or, it could mean that there is an incomplete medical record, missing signatures, or other essential documents.
2. Incorrect coding: Make sure that your team members have the most updated coding manuals. The use of outdated or incorrect coding can cause a claim denial, whether that’s ICD-10, CPT, or HCPCS codes. And always make sure that you’re being as specific as possible, adding modifiers as appropriate. If they’re missing or incorrect, this can cause a denial.
3. Eligibility: Make sure that you keep up to date on patient authorizations. If patients are no longer eligible for Medicaid services, those claims will be denied. If you provide services that aren’t covered under a client’s plan, those will also be denied.
4. Late submission: Every payer specifies when to submit claims, whether that’s 15 or 30 days after the visit occurs, you must submit them on-time. If you submit them late or delay in getting documentation/signatures, those can also result in a denial. Lastly, if the EVV data is incorrect or the aggregator did not receive the data, that can mean a denial as well. 

Win More Medicaid Clients With CareTime By Your Side

Medicaid might not be the easiest payer to work with, but we hope that this introductory guide helps to set you up for success, no matter where you’re at in your home care journey. 

CareTime is an agency management system (and more) equipped to meet you where you are, and get you to where you want to be as an agency. With an automated rule engine to help you set-and-forget the billing settings you need for each payer and “billing while you sleep” which means exactly how it sounds, if you are interested in Medicaid or already serve Medicaid client, consider making a switch today. 

Grab your demo here.