Why do dentists accept Medicaid?

Discussion in 'Dental' started by predentlove, Sep 5, 2012.

  1. predentlove

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    Hello dentists,

    I was just wondering what your thoughts are on for dentists who accept medicaid.

    Why do dentists choose to accept medicaid knowing that they will receive significantly lower funds than if they didn't?

    Are dentists who accept medicaid bound to it for life?

    Is it possible to pay off all loans and accept medicaid?

    What are the pros and cons?

    Thanks SDN
    - just curious
     
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    #1 predentlove, Sep 5, 2012
    Last edited: Sep 5, 2012
  2. GTFOOMICT

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    Cuz if you control expenses and ramp up production, some state fee schedules allow for a small or sizable profit.
     
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  3. The Anhedonia

    The Anhedonia Winner Winner Chicken Dinner
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    to add, this is why you'll hear the term "medicaid mill" thrown around. to offset the relatively lower reimbursement rates (which isn't necessarily low depending on what state you are practicing in), dentists accepting medicaid see an ungodly amount of patients on a daily basis.

    if you're a pediatric dentist practicing in NY or MA it's pretty good as their Medicaid programs are generous (maybe a stretch of the word) compared to other states.
     
  4. DrJeff

    DrJeff Senior Member
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    There are probably as many reason why dentists accept medicaid as there are dentists. It will range anywhere from the financial need to fill empty chair time all the way to the feeling of a social responsibilty to help those out who are on hardtimes.

    A dentist isn't bound to accept medicaid for life (although i'm sure that there are plenty of legislative folks that would love to make us :mad: :eek: ). A dentist can enroll as a medicaid provider and then stop taking medicaid anytime he/she wants (sometimes they can start or terminate almost immediately other times it may be on a monthly, quarterly or annual start/stop date on a state by state basis)

    There are plenty of dentists who do pay off their loans from accepting medicaid fees for sure, and there are also plenty who can't - it's all based on loan size and practice volume and how YOU manage the overhead, and hence cashflow, of your office

    Pro's and Con's, well that's most likely has a highly person to person answer based on their location and situation. Why I personally accept and see about 20% of my practice fileld with medicaid patients is likely different than why you may or may not see medicaid patients and in what volume. For me atleast it's a combo of feeling a bit of a social responsibility, a bit of having a little extra time in my schedule where I can reasonably fill spaces in my 2nd operatory, and also the fact that when I go and talk to a politician about what does and doesn't work with respect to legislation and dentistry AND they ask me if I see medicaid patients, I can look them straight in the eye and say "yes" I have #x hundred of medicaid patients in my practice and as such end up writing off $Y a year in medicaid fees while treating them, and then, particularly if i'm feeling a bit aggrevated with that politician, ask them how much "free" care or services they provided last year to the medicaid population?! ;)

    The biggest con for me personally isn't financial, but frustration on the part of how far too many medicaid patients DON'T take the steps to make the diet and/or lifestyle changes that they need to to prevent the dental symptoms that they often have from returning. I personally feel that that happens since the medicaid patient the vast majority of the time has no financial responsibility for their care and as such doesn't often have the same feeling of ownership and hence desire to take care of the work that was done. The incidence of need for retreating a recently treated area of decay in a medicaid patient vs a self pay patient in my practice atleast is i'd say about 5 times greater. Both patients get the same amount of diet and hygiene education, both patients get the same quality of work using the exact same materials, but all too often it's the patients that have to open up their wallets and pay for the work who make the changes that caused the need for the work in the 1st place, vs. those that don't have to pay anything. I strongly feel having seen 1st hand this scenario play out time and time again over the last decade plus, I feel that when someone gets something for nothing that all too often they treat it like nothing, and when it's YOUR work that they treat like nothing AND you took a pay cut for your efforts, it can get frustrating as from a clinician's, business person's, and humanitarian's perspective
     
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    #4 DrJeff, Sep 5, 2012
    Last edited: Sep 5, 2012
  5. awaitsimpatient

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    The truth is that Dentists DO accept medicaid and hope the patient never shows up!
    REASON : medicaid is HMO so Dentists have patients assigned to their office and if patient doesn't visit office regularly, the dentists still get paid a capitation fee every month. YOU GET IT.. Dentist gets paid every month a few dollars per patient assigned to their office whether the patient shows up or not! if the patient does Shows up then the dentist have to do work approved by insurance and get paid like 15$ for extraction.
    lets say insurance pays you $10 per head ( capitation) and you have 1000 patients assigned to your office.. you should be getting about 10K monthly without any work!! but also have to consider that insurance company limits the amount of patients send to your office.. Hope it helped!
     
  6. DrJeff

    DrJeff Senior Member
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    Not all state medicaid programs operate in the fashion that you described where patients are assigned to a particular provider and then the provider is reimbursed a flat fee per patient per month.

    In CT where I practice, medicaid participants have their choice about what provider they want to see (or that will accept them as a patient), and they aren't assigned to 1 given provider. As a medicaid provider, I can also choose how many (or few) medicaid patients I want to see, and can even be so selective as to restrict the medicaid patients that I see to say kids only, etc. I am also reimbursed by the CT medicaid system on a per procedure, not a per patient system. If I do 4 fillings on a medicaid patient, I bill for, a receive payment for 4 fillings. If I see that same medicaid patient 3 times in one month and do say 10 fillings on them over those 3 visits, I get reimbursed for all 10 of those fillings, not just 1 monthly flat fee.

    Where medicaid in CT differs from say a "traditional" private insured patient is both in the fee schedule, the covered procedures and also what procedures need pre authorization. The fee schedule for medicaid procedures in CT is set at the 80% level statewide. Meaning that when they last set the medicaid rates about 5 years ago, the reimbursement rate would be equal to, or above what 80% of the offices in the state would usually get. These rates applied to medicaid enrollees age 21 and under. For those over age 21, the reimbursement rate is 52% of what the under 21 rate is. Prior approval is needed for all endo's, crowns (both of which have approval tending to be based on if the patient has any missing teeth in their mouth), dentures, pulpotomies, stainless steel crowns. The amount of retrospective chart reviews of these patients is also far greater than for a private insurance patient, as well as the number of initial denials that my office receives(even for procedures where there's no exclusionary reason that we can see - especially true for adults). Basically my staff has to do typically 2 to 3 times the amount of paper work that they typically would for my medicaid patients compared to my "private" insurance patients, for less of a reimbursement. As an asside, financially this will often work, as in atleast the area where I practice, the medicaid patients that I treat tend to have a higher decay rate, and as such need more work on a more regular basis than my private insurance and/or self pay patients do. That fact alone allows for the finances to work out since the volume of work is higher, and from an overhead perspective, there's not too much of a difference if I'm doing say 3 fillings vs. 1 filling in terms of how long it takes me and how much material I use, so it can work out. Items like endo's and crowns work financially for those under 21, and for those over 21, my margin is much tighter, but it does work with the fees that CT pays currently.

    Not all states have the same system and//or fees that CT does though, and up until a childrens health advocacy group sued the state of CT over the at that time very poor reimbursement rates, things weren't as they are right now. After the state lost the lawsuit and the rates went up to where they are now, CT, which currently has about 2500 licensed dentists statewide, went from have about 150 medicaid dental providers to now having over 1500 medicaid dental providers, and now is in a situation where multiple advocacy groups and the administrators of the program in CT have determined that for kids, there is no longer an access problem, as kids can get an emergency appointment within 24hrs of calling and on average will be offered a cleaning appointment within 10 days of when they call. The state basically made the fees "fair" so that we, the generally speaking small business owners who are providing the care, can see and treat this population of patients in a way that allows us financially to operate our businesses. Is it perfect?? By no means would I say yes to that. But does it work and have more pros than cons?? yes
     
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  7. djeffreyt

    djeffreyt Senior Member
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    Medicaid in Texas is not HMO. It's paid by the procedure and run through individual insurance companies. The reimbursement rates are just above average probably, not as good as CT, Maine, etc, but good.

    I've worked in a lot of practices in my short time as a dentist which varied from 20% Medicaid patient to 90%. Not hard number, just that's about how many they had. Some places started accepting it to fill up the emptier times on the schedules. Other's just focused almost solely on this sector of the market and yes, way overbooked patients.
     
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  8. Daurang

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    I've never heard of Medicaid operating as a DMO. I'm sure you're misinformed, unless you can name one state that operate like that.
     
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  9. Smurf12

    Smurf12 NoShirtNoShoesNoService

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    Is it possible to pay off all loans and accept medicaid?

    Of course! A few out there even have some spare change to fuel their private jets
    , no joke.

    Here are some extra reads:
    Dentist in Medicaid suit adding a water park to his mansion


    Feds investigate Texas dental Medicaid program

    Questions surround lucrative Medicaid dental business

    But then again this is in Texas. I have no idea how medicaid works in other states.

    I personally met one myself(even offered me a position as a dentist. When I graduate as one of course.), the guy isn't practicing anymore. I think they are lobbying right now as we speak.

    Although this is not my motive for pursuing dentistry, but I find it quite hilarious when this shows up in my news feed. This also seems to be brought up by many other predents at my school(Tisk, Tisk, Tisk....)
     
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  10. Toni Scott

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    ... side note.... bit of help for Medicaid dentists right now is that they can apply for the EHR Incentive Payment Program. It's not an easy process to get through but we handle ehr incentive applications all day long for some really hard working dentists that deserve that money. I've met some wonderful people who feel strongly about serving this community.
     
    #10 Toni Scott, Apr 17, 2016
    Last edited: Apr 17, 2016
  11. cacajuate

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    Because Medicaid always pays and you don't have to deal with collecting payment.
     
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  12. toothdriller2k17

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    depends on the state you work in. some states have great reimbursement, while others don't
     
  13. browncrack

    browncrack Flood Damage
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    I wish I could say this better myself. You work harder to educate patients that do poorer in diet/lifestyle decisions. Then your staff has to deal with aggressive medicaid paperwork for reimbursement that is much less than private insurance. You also do not get paid for the retreated filling when the patient loses their toothbrush for four months. You might even get audited and have to return payment to the state.
     
  14. MahiMahi

    MahiMahi Optimism
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    I'm not a dentist, but I would hope that it's done from a sense of social responsibility. Yes, it certainly pays less than a private insurance patient and can be challenging (according to all the practicing dentists who chimed in), but most of these patients wouldn't be able to access regular care otherwise. If it's not a dental professional's responsibility to address a societal need for dental care, what's supposed to happen to those without means to pay for care, and who don't live near a school clinic?
     
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  15. TikiTorches

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    Let us know how you feel after completing Dental school, mahimahi. How much will your loans be when you finish
     
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  16. jda02624

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    I agree with you, at least in theory, but as someone that has treated a lot of Medicaid patients in my career I can tell you that there are a lot of people that do not care half as much as you do about their own responsibility as patients. Because they are getting "free" treatment, they don't have any sense of responsibility to show up for appointments, take care of their teeth (or braces if in ortho), etc. It's a struggle to be a provider, that's why you see a lot of practitioners supplementing the lower reimbursement and patient compliance with increased volume of patients. You may have a different view once you start practicing, your benevolence may not be as great as it is now.
     
  17. MahiMahi

    MahiMahi Optimism
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    I have yet to treat a patient. I'll be applying this summer, and I'm planning/hoping to go to the school that will leave me with the lowest debt burden afterwards, so I'll have more freedom in practicing. I've heard the horror stories, and I don't want to feel the pressure of a jumbo dental school loan hanging over my head to live in a certain area, work for a certain corporate practice, or overtreat to meet my loan obligations.

    My opinion also has a bit of a personal angle. Despite both of my parents working full-time and being financially responsible, we were really poor when I was growing up. All our family's dental care was done through public programs or sliding scales or school clinics, so I'm really thankful we were able to get access to care in the rare situations when we needed it. I know there are tons of poor folks who don't pay attention to their dental hygiene, and there are most certainly some who take the social safety net for granted, but there are families out there who do try hard when it comes to oral hygiene, and will be incredibly appreciative about the care we receive.
    (My mom would actually time my brother and I when we brushed, and she made sure we said "thank you, sir" after every visit, I still remember it.)

    Then again, my opinion may completely change once I've actually practiced a day in my life. It's easy to be idealistic, but I'm really trying to prepare before dental school when it comes to picking a school and having manageable loans.
     
  18. TikiTorches

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    You can work at a school. They treat many patients
     
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  19. PhoenixFire

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    :thumbup:
    I agree. Not all poor people have entitlement attitude.

    Then the problem is not with social welfare. The problem is with exorbitant cost of education.
     
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  20. oralcare123

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    Because on top of "per capita" and other relatively small charges dentist can ask patient to pay for something, which is not covered by insurance.
    Or you can advise unnecessary treatment as well - patient would not know.
    Some of the pearls are: irrigation of pockets for $400, custom shade for $200 and bone graft after a wisdom tooth removal
     
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