How Medicaid effect billing process in EMS system

Medicaid is among the sub-branches in the emergency medical system (EMS), which was established in 1965 alongside the Medicare with the sole aim of providing coverage for health care to the groups that are economically disadvantaged. Historically, programs like Medicare and Medicaid were funded through the municipal budgets process. However with municipalities being faced with budget shortfalls, this has pushed the service providers of Medicaid to search for revenue production opportunities via billing process. The Medicaid involves the joint effort that is between the federal government and individual states where the federal government matches up 50 to 79 % of administrative and medical costs by the state. The state contribution to Medicaid differ according to the per capital income with each state having its own criteria on benefit levels and eligibility for the Medicaid. Medicaid programs in 1996 covered an average of 13.8 % of the civilian population in the United States and therefore, affect the billing process for it forbids beneficiaries deductibles or those that require co-payments (Fitzpatrick and Wallace 45).

According to the Department of Community Health (1), many states have witnessed the need for efforts on cost-containment in the running of the Medicaid programs where prospective reimbursement is considered. In fact, only a few states in the United States today use the retrospective reimbursement of the funds for the Medicaid programs. The prospective reimbursement is mostly used and successful, but states like Arizona and California employ the selective and competitive bidding for the billing process in Medicaid. As a result of the priority given to the programs of Medicaid in the United States, 49 states currently give Medicaid programs in the form of managed care. In the efforts to increase cost containment, at least 38 states are looking into the viable solutions thus mainstreaming the Medicaid. More citizens are covered through this process and this call for changes in the billing process given that states contract the private services for the programs of managed care (Deutscher 1).

However, the efforts in cost-containment have thus brought transition resulting to managed care programs of the Medicaid arising mixed reactions on the medical care quality, saving money as well as the improved access to Medicaid programs. The billing process in Medicaid has therefore changed compared to the billing process of Medicare. This is because Medicaid programs take into consideration the care reimbursement in the prehospital patient transportation and has to account for services offered for compensation to the service providers. As stipulated in state plans, Medicaid service providers should ensure the transportation of the recipients to the service providers and from as well as the methods used in this process (Green 7).

In a way the Medicaid has significantly changed the billing system in which it has resulted into standard and simplified billing process enhancing streamlined system how the bills of other professionals in health and physicians as well bill the Medicaid programs. Medicaid has thus adopted the electronic billing process, which is efficient today. In-house billing system was operational for years but with poor services and returns being experienced. According to Buchbinder and Shanks (73), 60% of the personnel in 1995 involved in the EMS were trained to carry out the in-house billing process, but the failure in the billing system indicated the method was not efficient and resulted in dwindling provision of health services to the American citizens. If the health care service providers are not compensated then health programs like Medicaid are bound to fail. The Medicaid program in Michigan has successfully provided health cover to almost 1.1 million citizens in the state. This has been possible because the Medicaid has adopted electronic billing system that is standardized nationally and coding system that is easier to use by the service providers. Another plan that has ensured efficiency in the billing process in Medicaid programs is the implementation of the Internet modern training programs which has improved the working state of the insurance billers (Department of Community Health 1). Information technology has significantly played a pivotal role in electronic billing process infusing to the system convenience and time. Medicaid programs have been more than willing to incorporate stakeholders so that they are kept abreast with modern billing systems and adopting them for efficiency, uniform, and standardized billing process. This is why the Medicaid programs are a step toward meeting the set standards of the Health Insurance Portability and Accountability Act (HIPAA) (Bronstein et al 253).

The Medicaid adoption of the simplified, standard, and uniform billing system with standard coding system has pushed the billing process miles ahead leading to efficiency in the health sector. The stakeholders have thus been able to receive compensation for services rendered, fewer errors in the electronic billing system, and improved health services as a result of prompt and timely payments. Moreover, more American citizens have been covered in the health care scheme thus able to meet the health care costs that over the last five years skyrocketed beyond their ordinary financial reach. If the electronic billing process is implemented, then the American citizens will enjoy health care with efficiency culminating to more people covered by insurance health schemes (Latifi 89).

In conclusion, the billing system due to the plans implemented in connection with Medicaid programs had kept the billing system abreast with the in vogue information technology. The electronic billing unlike the in-house billing has become quite efficient, convenient and minimized errors leading to prompt and timely payments for the sufficient provision of the health services without a hitch. Therefore, Medicaid has significantly transformed the billing system to the state where the contemporary society can appreciate it for the benefits it brings along.

2016-11-07T14:29:36+00:00 By |Categories: 例文專用|