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Interstate Medicaid Billing – Problems & Procedure

Author: Niurka Moreno
by Niurka Moreno
Posted: Oct 30, 2014
medicaid patients

Unlike Medicare that offers only limited healthcare benefits, Medicaid makes available a wide range of health benefits to citizens who are below the poverty line. One of the main disadvantages of Medicaid is that not many Providers are registered with the Medicaid program due to the low reimbursement. Eventually, billing Medicaid plans becomes harder when compared to Medicare billing. Besides, there is an added disadvantage when it comes to interstate Medicaid medical billing and collections. Let us understand the problems involved in interstate Medicaid billing:

Why do Providers avoid Medicaid Patients?

  • Due to low reimbursement rates, many Providers display hesitation in accepting Medicaid patients.

  • Medicaid payments vary from state to state. A study made by the Menlo Park, California-based Kaiser Family Foundation (2003 – 2009), revealed that Illinois’s rates were the lowest in the whole nation. Therefore, there is a huge shortage of Providers accepting Medicaid patients in this particular state.

  • The government has not increased the Medicaid payments for a long time. For instance, Kentucky has not raised Providers’ Medicaid payments since 1993. Ohio faces the same issue as well.

  • When interviewed, many Providers claimed that they had to wait for a long time to get their reimbursements from the state Medicaid programs. When it is out of state, it takes even longer.

  • In addition to taking care of various administrative services like medical billing and collections, healthcare denial management and patient eligibility verification, Providers complained that they had to do complex paperwork.

  • All these issues make Medicaid medical billing and collections a tough task.

What is Interstate Medicaid Billing?

During an emergency or in unavoidable situations, Medicaid patients are eligible to get care from Providers who are out of state. Billing such services is called as interstate Medicaid billing. It is important that a Provider accepts the other state’s payment even if it is zero, as long as it is not a denial.

Problems involved in Interstate Medicaid Billing:

  • As Medicaid payments vary from one state to another, Providers refuse to accept another state’s payments if it is less, when compared to their state’s Medicaid payments.

  • As a result, Providers bill the patients so as to pay for the balance amount.

  • Filling and refilling prescriptions provided by out-of-state Providers becomes a big problem after a Medicaid patient returns to his/her home state.

  • Sometimes, traveling out of state becomes unavoidable for Medicaid patients due to the unavailability of certain medical services in their home state. In such cases, Providers refuse to accept another state’s Medicaid payments.

It is the duty of every Provider to offer quality care to Medicaid patients like how they would provide to Medicare patients. To overcome the problems involved in interstate Medicaid billing, Providers can get help from outsourced medical billing companies.

About MGSI:

MGSI is adept in handling interstate Medicaid medical billing and collections prudently. Therefore, Providers can get help from this top-notch outsourced medical billing company that has more than 20 years of experience in the healthcare space. Based in Florida, MGSI is a national billing company that has been managing medical billing and collections, patient eligibility verification, and healthcare denial management without a glitch. To learn more details, log on to

About the Author

In order to keep your practices running smoothly without any impact from the Aca changes, outsourcing medical billing will be the right option.To learn more details, log on to

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Author: Niurka Moreno

Niurka Moreno

Member since: Aug 28, 2014
Published articles: 9

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