Why in the world would you take Medicare? My understanding is they pay horribly. I don't think anybody takes Medicare where I live except community mental health places. Jeez, I don't even think my university residency clinic accepted it. We also didn't accept Medicaid.
As shikma said, medicare in many places pays more than some insurers. It's not horrible here at all- I could make good money filling up with medicare patients. You are right that medicaid does pay horribly, and my main job doesn't take that(not many others do either).
Interestingly though, probably the bigger reason most private practices don't take medicaid is that this population just can't get to appts reliably. I've crunched the numbers and I could do ok with medicaid if I booked appropriately, but the problem is they won't show up. Transportation issues and whatnot.
Another thing to consider is what you get for the visit and what 'they pay' are two different things.....just because I make less on a medicaid visit at my contract cmhc job(I get a certain percentage of collections) doesn't mean they actually pay less. For example, lets say medicaid reimburses 67 dollars for a 99214 and a certain insurance company reimburses 85 dollars. Well if the pt's copay is 50 dollars(and copays are going through the roof), medicaid actually 'pays more' than the supposedly good private insurance. They are sending you more money. On an ideal visit(if the pt pays their big copay and you have no problems collecting it or their deductible...which is another matter) you will make more than the medicaid visit because there are two people paying(pt and insurer), whereas with medicaid visits only one person pays a non-trivial amount(medicaid).
Another deal breaker with medicaid is that you can't typically do 99214 + 90833 because they are generally going to see the therapist on the same day, and they won't allow you to bill two therapy codes on the same day. So you are out a ton. If it weren't for this I'd take medicaid in a private practice. In our pp we tell the patients they have to schedule with therapist on a separate day so we can do the 90833 for me(if they saw therapist same day we couldn't.....for patients who travel very very long distances we may occasionally make exceptions I think). Interestingly the medicaid 99214 is actually worth more than some of the insurance 99214s(but the insurance 99214 + 90833 would be worth more)....yes, you read that right.
I think maybe some of you guys are in better parts of the country for insurance reimbursements. Here the codes *really really suck*. And in the other two places I've worked for any period of time they were different but they also really really sucked. And honestly, I think even in the places where the codes pay better now we are going to see that trend....with higher deductibles, higher copays, etc...which means in the end they are paying less to you.
