Do you accept Medicaid in your Practice? Why or why not?

[mahfouz]

I thought this would be a good topic to get a discussion going on. For all of the practicing dentists out there, how many of your practices accept Medicaid? Do you find it lucrative or is the reimbursement rate low? Is it easier to deal with Medicaid than other insurances? If you take medicaid, how do you keep your overhead low?

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[mike3kgt]

I thought this would be a good topic to get a discussion going on. For all of the practicing dentists out there, how many of your practices accept Medicaid? Do you find it lucrative or is the reimbursement rate low? Is it easier to deal with Medicaid than other insurances? If you take medicaid, how do you keep your overhead low?

My favorite part of treating medicaid patients: getting them to say "Doctor, I think the baby stole my calcium!"

Other than that, no reason to participate with the evil known as medicaid.

 

[OhioDMD]

When I first opened (31 years ago) I accepted Medicaid. Reimbursement was low but they filled the
schedule and paid the bills. They were never scheduled during premium hours (late afternoon, evening
or Saturdays when we worked them) and as the practice grew we phased out gradually (not accepting
new pts, phasing out non-productive procedures and dismissing no-shows). However, I still treat my handicapped Medicaid and any long-term pts that may fall on difficult times for as long as the great state
of Ohio doesn't make it too big a PIA to keep my provider number active.

 

[charlestweed]

The medicaid reimbursement is low but it is still better than nothing. If you don't have enough cash and insurance patients to fill your appointment book, then it is foolish not to accept medicaid. It at least helps you cover some of the fixed expenses (which you have to pay anyway) such as staff salaries, utility bills, rents etc.

My friend told me that last week he did a premolar endo for $200 because this was the only patient he had on that day. To him, $200 is still better than sitting around doing nothing. That's how he is able to survive in the saturated market in southern California. That's how he was able to pay off his student loans, his $700k home mortgage. He has practiced dentistry for 15 years. Now, he only works 4 days a week. When he is not at work, he stays home (which is only 10 minutes from his practice) taking care of his koi fish. During the snow season, he tells his staff to block Fridays and Saturdays so he can go ski with his friends. That's the kind of lifestyle I want to have….and I am working toward this goal by accepting anything (medicaid, low fees) that helps pay the bill. When I am 100% debt free, I don't have to worry about the future of dentistry….if is on the decline or not.

Oh, one more thing. It is your loss not to accept medicaid if the competitors around you (dental chains and other private practices) accept medicaid.

 

[yappy]

Charles,

What you say makes alot of sense but I was shadowing a GP dentist who said that they do not accept medicaid because of the lower reimbursement. They actually have a full schedule 5 days per week and do multiple crowns on patients in one visit via cerec. Patients also participate in the extra-dental services like nutrition and massage.

One patient came in and got 2 rct, crowns, and made an appointment to come back for an exo and implant. After he left the dental assistant told me that his insurance has no cap/yr and pays 85% of the tx. I also noticed each patient seemed to ASK for things like botox and mouth guards lol. They had 3 dental chairs, 3 hygiene charis, nutritionist + supploments, and a massage therapist. It was amazing.

Surely this office, and others like it, would be waisting their time accepting medicaid and would be considered competitive.

 

[HupHolland]

Charles,

What you say makes alot of sense but I was shadowing a GP dentist who said that they do not accept medicaid because of the lower reimbursement. They actually have a full schedule 5 days per week and do multiple crowns on patients in one visit via cerec. Patients also participate in the extra-dental services like nutrition and massage.

One patient came in and got 2 rct, crowns, and made an appointment to come back for an exo and implant. After he left the dental assistant told me that his insurance has no cap/yr and pays 85% of the tx. I also noticed each patient seemed to ASK for things like botox and mouth guards lol. They had 3 dental chairs, 3 hygiene charis, nutritionist + supploments, and a massage therapist. It was amazing.

Surely this office, and others like it, would be waisting their time accepting medicaid and would be considered competitive.

sounds like clueless DA

 

[gryffindor]

sounds like clueless DA

Are you sure? When I was a resident, I shadowed at a practice located near various corporate headquarters. Some of the higher level execs that came had much better dental benefit packages than the regular employees of the company. That type of patient would fit right in at a practice offering nutrition pills and massages on the side and wondering if they should get a mouthguard for the kickboxing class at the gym.

 

[Xigris14]

So true. Poor people with no education. Smokers, obese, etc. The worst of the worst. Not your best tooth brushing patients. Most medicaid brush their teeth with the but of a cigarette or bottle of jim beam. Here is to Obama and making more people eligible for medicaid. God help us.

 

[zehl3]

Medicaid ensures our most vulnerable citizens have access to needed dental care. Not accepting Medicaid is criminal.

 

[senpai]

Medicaid ensures our most vulnerable citizens have access to needed dental care. Not accepting Medicaid is criminal.

No, the gov only reimbursing at 55% of the Market fees for these pt's is what's criminal.

 

[zehl3]

No, the gov only reimbursing at 55% of the Market fees for these pt's is what's criminal.

The patients on Medicaid do not dictate the reimbursement rate the government sets. YES there are people that abuse the system. YES the reimbursement to dentists is below market fees, but do not refuse service to low-income families because you're not making enough money off them.

 

[thewingman]

The patients on Medicaid do not dictate the reimbursement rate the government sets. YES there are people that abuse the system. YES the reimbursement to dentists is below market fees, but do not refuse service to low-income families because you're not making enough money off them.

Running a clinic cost money and someone has to pay for this. What is unfortunate is that they government does not pay what it should. Moreover, while there might be many individuals that are good patients, many patients are a pain to manage - do not show up/are not compliant with what is recommended.

 

[mike3kgt]

Medicaid ensures our most vulnerable citizens have access to needed dental care. Not accepting Medicaid is criminal.

Typical idealistic dental student who has been conned by their dental schools to actually believe in what is said in the above.

I hope there are more dental students like you who plan on accepting medicaid... it will take the burden off of guys and gals like me who would rather retire their dental licenses rather than participate with medicaid.

And, keep in mind, it's not only about re-imbursement rates. I can assure you that this is what most people (including the public) believes... rich doctors don't want to take a pay cut to treat the "disadvantaged." Bull@#$.

Do yourself a favor and read some more about medicaid and it's impact beyond economics, including liability of patient care, government infringement upon practice, and the potential for serious and often unfounded judicial/criminal liability.

Dental practices are a business and by keeping a healthy business model, you can increase your care to more people. Excessive profiteering is bad for our profession but you simply need to run a good business to stay satisfied as a dentist.

 

[zehl3]

Typical idealistic dental student who has been conned by their dental schools to actually believe in what is said in the above.

I hope there are more dental students like you who plan on accepting medicaid... it will take the burden off of guys and gals like me who would rather retire their dental licenses rather than participate with medicaid.

And, keep in mind, it's not only about re-imbursement rates. I can assure you that this is what most people (including the public) believes... rich doctors don't want to take a pay cut to treat the "disadvantaged." Bull@#$.

Do yourself a favor and read some more about medicaid and it's impact beyond economics, including liability of patient care, government infringement upon practice, and the potential for serious and often unfounded judicial/criminal liability.

Dental practices are a business and by keeping a healthy business model, you can increase your care to more people. Excessive profiteering is bad for our profession but you simply need to run a good business to stay satisfied as a dentist.

You raise some interesting points.

However, I still feel that dentists should not flat out refuse Medicaid patients. Do your part by accepting (and maybe capping) Medicaid patients.

 

[senpai]

You raise some interesting points.

However, I still feel that dentists should not flat out refuse Medicaid patients. Do you part by accepting (and maybe capping) Medicaid patients.

Again, Dentist's are not the problem, it's the government. You do your part and write your congressman and tell them to either make it easier on us to treat these pt's or get the hell out of the business of telling us how to run our businesses. That goes for you as well.
Most dentists do plenty of free work, lower their fees for individuals who can't afford, and are more than willing to to work with people through payment plans, etc. However, we are not willing to accommodate the government trying to interfere with how we provide care to patients.
Oral Health Services should be between the Doctor and the Patient, not Government bureaucratic dictating to the Doctor and Patient how these services are administered.
Just another example of how government intervention and entitlements are nothing but money sinks, lower the quality of and access to care, and puts undue burden on Doctors and Patients.

 

[mike3kgt]

Again, Dentist's are not the problem, it's the government. You do your part and write your congressman and tell them to either make it easier on us to treat these pt's or get the hell out of the business of telling us how to run our businesses. That goes for you as well.
Most dentists do plenty of free work, lower their fees for individuals who can't afford, and are more than willing to to work with people through payment plans, etc. However, we are not willing to accommodate the government trying to interfere with how we provide care to patients.
Oral Health Services should be between the Doctor and the Patient, not Government bureaucratic dictating to the Doctor and Patient how these services are administered.
Just another example of how government intervention and entitlements are nothing but money sinks, lower the quality of and access to care, and puts undue burden on Doctors and Patients.

 

[agape4unme]

The Dental Economics journal from Nov 2011 had a study in it that stated that Medicaid patients are FOUR TIMES more likely to SUE than a self pay/commercial insurer.

Enough said.

 

[mike3kgt]

Again, Dentist's are not the problem...

As much as I agree with your post, there are plenty of dentists who are the problem. Just on another topic there was a dental student (I think) that posted:

---------------

"Critique my business plan":

Work as an associate for a year or two.

Purchase an existing practice that's already grossing 750K or thereabouts.

Hire an associate(s) to do most of the work at that office. He gets 70ish% profit while I retain 30% profit.

Replace associates as necessary.

Do the same thing at other locations in the U.S. until I'm making my goal amount of 500K per annum.

--------

I would assume this guy would jump at the opportunity to have 10+ medicaid clinics and make the associates deal with all of the crap that is involved. All with $$ as the goal.

Yes, the vast majority of people go into dentistry (myself included) because it's a very good chance of a good life including a good salary but we cannot forget we are healthcare providers. But the fact is that we're dealing with human beings here, not widgets. Treat patients well and the $$ will follow.

 

[charlestweed]

As much as I agree with your post, there are plenty of dentists who are the problem. Just on another topic there was a dental student (I think) that posted:

---------------

"Critique my business plan":

Work as an associate for a year or two.

Purchase an existing practice that's already grossing 750K or thereabouts.

Hire an associate(s) to do most of the work at that office. He gets 70ish% profit while I retain 30% profit.

Replace associates as necessary.

Do the same thing at other locations in the U.S. until I'm making my goal amount of 500K per annum.

--------

I would assume this guy would jump at the opportunity to have 10+ medicaid clinics and make the associates deal with all of the crap that is involved. All with $$ as the goal.

Yes, the vast majority of people go into dentistry (myself included) because it's a very good chance of a good life including a good salary but we cannot forget we are healthcare providers. But the fact is that we're dealing with human beings here, not widgets. Treat patients well and the $$ will follow.

When your office accepts medicaid, that doesn’t mean that your office will be flooded with patients. There are other dental offices in the same area that accept medicaid as well. I know plenty of medicaid offices in CA that have had hard time getting patients to fill their appointment book. And you can’t just do anything you want. For the medicaid to pay your office, you must prove (by submitting photograph, X rays, study models etc) that the procedures you perform are necessary.

I think it is unfair to assume that when a dentist accepts medicaid, he/she must do unethical treatments and fraudulent billing in order to make up for the low reimbursement. There are plenty of honest, hard working dentists (especially the Asian ones) who are willing to work hard for less money. I’ve seen some high-end offices that do much worse things to their patients.

 

[Adversary]

I tried looking for the article in the November 2011 issue of Dental Economics and couldn't find it. Can you tell me which title it is under?

http://www.dentaleconomics.com/index/current-issue/dental-economics/volume-101/issue-11.html

The Dental Economics journal from Nov 2011 had a study in it that stated that Medicaid patients are FOUR TIMES more likely to SUE than a self pay/commercial insurer.

Enough said.

 

[mixoma]

Depending on the state you practice medicaid can be lucrative if you are clinically fast and do quadrant dentistry. Why do you think peds make $$$$ these days, its not because people pay cash or there insurance has a good reimbursement. They milk medicaid for every penny. Most states you can charge for oral hygiene instructions at every visit done by the assistant ect.

 

[mike3kgt]

When your office accepts medicaid, that doesn’t mean that your office will be flooded with patients. There are other dental offices in the same area that accept medicaid as well. I know plenty of medicaid offices in CA that have had hard time getting patients to fill their appointment book. And you can’t just do anything you want. For the medicaid to pay your office, you must prove (by submitting photograph, X rays, study models etc) that the procedures you perform are necessary.

I think it is unfair to assume that when a dentist accepts medicaid, he/she must do unethical treatments and fraudulent billing in order to make up for the low reimbursement. There are plenty of honest, hard working dentists (especially the Asian ones) who are willing to work hard for less money. I’ve seen some high-end offices that do much worse things to their patients.

This is clearly much different than many other states. I know that personally in Ohio and Florida that if you sign up for medicaid, you'll literally be flooded with patients within days. You are legally not permitted to schedule specific days/times for medicaid patients... i.e. you cannot make "Friday my medicaid day" or "We only take medicaid patients between 10am-2pm".

The vast majority of practices that I have known about with medicaid systems were clearly in it for the $$ and nothing else. You only need to prior-auth for major work in Ohio (boney thirds, dentures/rpds) and in FL medicaid is only for children.

CA may be different but maybe it's because there are so many dentists the pressure for "normal" practices to accept medicaid is much higher than other states... but this is just a guess.

 

[crazy_sherm]

California Medicaid (Medi-Cal) has not covered adult full scope dental since June 2009. It is now limited to just emergency pallative care - exts and pulpectomies. Children (21 and under) are still covered.

I work at a Federally Qualified Healthcare Center (FQHC) and Medi-Cal pedo is what keeps our doors open. Our reimbursement is based on a our costs incurred and set annually by Medi-Cal. Rather than being paid per procedure, we are paid per visit. Our current rate is $233/visit. So we are paid $233 whether we see the patient for a prophy or a quadrant full of fillings. This allows us to avoid running the clinic like a mill (full mouth pulp/SSC on every kid that walks through the door) since we get paid just as much to help actually teach parents to prevent caries as we do to fill them. We can also book way more prophy or exam appointments in a day than we can restorative procedures. Between two dentists, we see about 55 patients a day. Money that we make on our pedo days is used to help fund our adult dental days, in which patients are on a sliding fee scale. Much of the revenue also goes to fund the medical side of the clinic which is always bleeding red.

On top of my salary here, which is nothing incredible, but certainly a livable wage - I signed up for loan repayment through the NHSC. I also get full benefits, a 403b plan, malpractice covered, license/DEA fees covered, vacation, sick time, and 5 days+$1000 of CE credit.

Some patients threaten to sue us, but management is quite accommodating to the patients and try to make them feel good about us to avoid trouble. However, our status as an FQHC actually makes suing us incredibly difficult. We're essentially partnered with the federal government, so they would have to also sue the federal government to get to us. There aren't too many lawyers who want to take up such a big case for a small payout for a pt who usually has an unfavorable history.

 

[charlestweed]

This is clearly much different than many other states. I know that personally in Ohio and Florida that if you sign up for medicaid, you'll literally be flooded with patients within days. You are legally not permitted to schedule specific days/times for medicaid patients... i.e. you cannot make "Friday my medicaid day" or "We only take medicaid patients between 10am-2pm".

It is very strict here in CA. In order to get paid for doing the interproximal fillings (class II/class III), the dentist has to submit the bitewing/PA radiographs. For occlusal and facial cavities, the dentist has to submit the intraoral photograph of the teeth that have the lesions.

The vast majority of practices that I have known about with medicaid systems were clearly in it for the $$ and nothing else. You only need to prior-auth for major work in Ohio (boney thirds, dentures/rpds) and in FL medicaid is only for children.

Of course, they are in it for the $$$. We all are. You even pointed out on your earlier post that dental practices are a business. A dental practice can't survive without patients. I find nothing is wrong with accepting medicaid. As long as you don't do anything unethical and illegal.

There are dentists who think it is not worth treating the medicaid patients because of the low reimbursement and high no-show rate. And there are dentists who are more realistic (because they recognize the oversaturation problem in their area and the student/business loan debts they still have)….they'd rather work hard for less by accepting medicaid and charging low fees than sitting around doing nothing. The bank, the landlord, the advertising company don't care if you have patients or not. You have to pay the bills ontime or file bankruptcy.

CA may be different but maybe it's because there are so many dentists the pressure for "normal" practices to accept medicaid is much higher than other states... but this is just a guess.

You are right about the dentists who practice in CA. You gotta accept everything in order to survive. I believe you are practicing in Florida, right? I thought Florida is very saturated as well. I also heard that FL starts accepting the NERBS exam.

 

[Medicaid Mom]

I am the foster mother of an awesome teenage boy. The town that I live in has over 100,000 people in it. There is not one dentist in this city or even in the county that accepts Medicaid, with the exception of one sketchy low-income all-purpose medical center located in "the hood" and staffed mostly by paraprofessionals. This boy has been through absolute hell and the administrative/ legal/ financial crap that he has to deal with continues to make his life so much more work than that of a boy who is not "in the system" - he needs SOMEBODY to cut him some slack! He is a wonderful person and a wonderful patient, brushes his teeth every morning and night, says please and thank you, is kind and appreciative, arrives at all appointments on time... and cannot get a decent dentist to take him. He's had no fillings to date but will eventually need dental care because his terrible past left him with significant nutritional deficiencies.

Not all people on Medicaid are irresponsible, lazy, unproductive citizens who choose to live off the system. My son is working incredibly hard to be a responsible and productive young man.

All I know is I'm not that unusual a person and there are a lot of kids "in the system" and foster parents who are struggling. This is so wrong. I realize that dealing with the government sucks, but we need these services. I work very hard for a much lower salary than your average dentist (I make $40k/yr) and the system doesn't pay us even enough per foster child to cover food, clothing, etc (regular foster care in our state is $225/month). But I'm having to try to figure out how to pay for good dental care for this wonderful boy. If a decent dentist in this city would just take Medicaid, both my son's and my life would be made significantly better.

I've heard many people say that they don't like so much welfare being made available, etc because such things should be taken care of by donations from people and private charities. They argue that there are lots of good people out there who would help out the truly unfortunate/ disadvantaged who are trying to make a better life for themselves. Well, where are those people and private charities, including those who are dentists, now? Surely if they would be willing to GIVE benefits to deserving kids such as my son, they would be willing to provide benefits for which they were even paid but simply less via Medicaid?

But apparently not.

 

[Andrew324]

What city/state/county?

 

[Lethstang]

I am the foster mother of an awesome teenage boy. The town that I live in has over 100,000 people in it. There is not one dentist in this city or even in the county that accepts Medicaid, with the exception of one sketchy low-income all-purpose medical center located in "the hood" and staffed mostly by paraprofessionals. This boy has been through absolute hell and the administrative/ legal/ financial crap that he has to deal with continues to make his life so much more work than that of a boy who is not "in the system" - he needs SOMEBODY to cut him some slack! He is a wonderful person and a wonderful patient, brushes his teeth every morning and night, says please and thank you, is kind and appreciative, arrives at all appointments on time... and cannot get a decent dentist to take him. He's had no fillings to date but will eventually need dental care because his terrible past left him with significant nutritional deficiencies.

Not all people on Medicaid are irresponsible, lazy, unproductive citizens who choose to live off the system. My son is working incredibly hard to be a responsible and productive young man.

All I know is I'm not that unusual a person and there are a lot of kids "in the system" and foster parents who are struggling. This is so wrong. I realize that dealing with the government sucks, but we need these services. I work very hard for a much lower salary than your average dentist (I make $40k/yr) and the system doesn't pay us even enough per foster child to cover food, clothing, etc (regular foster care in our state is $225/month). But I'm having to try to figure out how to pay for good dental care for this wonderful boy. If a decent dentist in this city would just take Medicaid, both my son's and my life would be made significantly better.

I've heard many people say that they don't like so much welfare being made available, etc because such things should be taken care of by donations from people and private charities. They argue that there are lots of good people out there who would help out the truly unfortunate/ disadvantaged who are trying to make a better life for themselves. Well, where are those people and private charities, including those who are dentists, now? Surely if they would be willing to GIVE benefits to deserving kids such as my son, they would be willing to provide benefits for which they were even paid but simply less via Medicaid?

But apparently not.

Thankyou for posting here. Your best bet is to widen your search to another county to find a medicaid dentist, or find a government medicaid clinic. Theyre everywhere and you will most assuredly find one within 45 minutes. Start your boy flossing at least 5x a week as an oz of prevention is worth a pound of cure. Use listerine 1-2x a day, its the only mouthwash on the market without a prescription whose use is more than cosmetic. Make sure hes using the modified bass method to brush and the proper way to floss, which can be gleaned from a google search. At your appointment request a perio charting to ensure no long term damage is being done to the periodontium. As long as he is in the clear for perio, he will most likely be healthy as a horse until he comes of age and can start saving for any long term care he may require such as ortho or replacing teeth he may have lost due to malnutrition.

To the young man earlier saying everyone should take medicaid, it will be interesting to talk to you in 8 years when you have 300k dental school debt, 150k undergrad debt, and 400k practice debt. After learning how to analyze a financial statement, the basics of managerial accounting, and finding out how detrimental to your license taking medicaid can be if youd still like to take medicaid instead of discussing how to fix the broken system then I salute you, youre a humanitarian.

Theres a reason most the medicaid clinics are government owned.

However, that being said there are dentists who make their living by running a medicaid practice. If youd like to be this type of dentist, seek them out pick their brains. I believe there is also some good CE you can do on the subject, though I havent taken it. From what Ive gathered, success hinges on bundling (or maybe it was unbundling. Its some kind of shennanigan related to procedure codes) procedures and working the reimbursement system.

 

[Silent Cool]

The medicaid reimbursement is low but it is still better than nothing. If you don’t have enough cash and insurance patients to fill your appointment book, then it is foolish not to accept medicaid. It at least helps you cover some of the fixed expenses (which you have to pay anyway) such as staff salaries, utility bills, rents etc.

My friend told me that last week he did a premolar endo for $200 because this was the only patient he had on that day. To him, $200 is still better than sitting around doing nothing. That’s how he is able to survive in the saturated market in southern California. That’s how he was able to pay off his student loans, his $700k home mortgage. He has practiced dentistry for 15 years. Now, he only works 4 days a week. When he is not at work, he stays home (which is only 10 minutes from his practice) taking care of his koi fish. During the snow season, he tells his staff to block Fridays and Saturdays so he can go ski with his friends. That’s the kind of lifestyle I want to have….and I am working toward this goal by accepting anything (medicaid, low fees) that helps pay the bill. When I am 100% debt free, I don’t have to worry about the future of dentistry….if is on the decline or not.

Oh, one more thing. It is your loss not to accept medicaid if the competitors around you (dental chains and other private practices) accept medicaid.

LOL. I laughed when I read this...it just seemed so...random