While denial rates for payors are improving, Medicaid’s aren’t budging much. The average denial rate for payors across the board is 6.8%. For Medicaid, that number is 18.5%! In four states, 30% of Medicaid claims are denied. Here’s the upside: States where Medicaid enrollment has been expanded under the ACA have had lower denial rates (13%) than those that chose not to (24%).
Your practice can fight for proper Medicaid reimbursement by designating a specific staffer to be your “Medicaid expert” when working denials. This person should devote their time to researching the ins and outs of Medicaid policies in your state, so that they will be well equipped to appeal claims right away.