Debating whether to sign a new Medicaid contract or not.

[Tobra]

This may degenerate into a political discussion, but thought I would give it a go.

All healthcare providers have to sign a new contract to participate in the Medicaid(Medi-Cal here) program as part of the Affordable Care Act. I have had a contract since I moved back here that has renewed automatically. The only reason I can think of that this would be needed, is because there is some sort of significant change in the contract. In reading the application, it is quite a bit different than the old one, there are 5 less places for it to be notarized, for example. There is some verbiage about compliance with all federal regulations that I don't see in the old contract. The thing is, there are over 20,000 pages of regulations that are new, and nobody has read, so it is a bit tough to know what I would be signing up for.

Medi-Cal dropped podiatry about 5 years ago. If someone has it as a primary insurance, they won't pay a podiatrist for providing services. If they have Medicare as primary, with Medi-Cal as secondary, which is quite common, they usually don't pay either, but they may. What happens is Medicare pays their end, say $80 for a $100 allowed charge, leaving Medi-Cal $20. They tell you that you already got paid $80, which is more than the $18(or whatever it happens to be) so we are not giving you anything. You get a few dollars at the beginning of the year, when Medicare deductibles have not been met. In the prior example, Medicare applies the $80 to the deductible, and Medi-Cal gives you the $18. If you are contracted with Medi-Cal, part of the agreement is that you can't bill the person for the balance. If not, you can bill them. If you get 1 out of 100 to actually pay you, you are still money ahead.

I have not been able to come up with a reason to sign a new contract with them, and thought I would throw it out for the PPOT brain trust to kick around.

[genrex]

How long is the contract good for? If you sign it, and then change your mind six months down the road for whatever reason, can you opt out then?

[jyl]

On a quick read, doesn't seem like any good reason for you to sign. Sounds like your specialty is effectively not covered, so that you would lose money on every patient visit. If that is correct, isn't it an easy analysis/decision?

[Rikao4]

given the extra reports..
& audits your staff would have to handle..
IMO..it's not worth it..

Rika

[Noah930]

But don't worry, you'll just make it up on volume.

[Tobra]

Hah, that is what that Aetna shill implied at the last conference I went to last June. I asked how they would compel doctors to participate in the exchanges. He said that it would be like discounted Medi-Cal, but all our patients would have insurance, so you would make it up in volume. I turned to the crowd and asked how many doctors accepted it, nobody raised their hand. I turned back to the insurance shill and said, "If you lose money on every one, you can't make it up on volume. That is not how math works."

He spent about 20 minutes trying to BS a roomful of people who knew more about it than he did. It started getting ugly after a while, like a thousand people laughing at him. I almost expected someone to throw a rotten tomato.

Yeah, it does not make much sense to sign that contract. I wonder what percentage of doctors will.