Medicaid Reimbursement in Nashville Tennessee, Research Paper Example

Medicaid reimbursement has been a problem for Nashville health providers for years. Doctors, dentists, and other health care providers rely on reimbursement by insurance companies and government programs like Medicaid in order to maintain their businesses. However, problems with Medicaid including low payouts and slow payouts have led to its exclusion by many providers in the Nashville area and, therefore, to limited choices by patients as to the providers whom they can see. This is possibly because, in these tough economic times, lawmakers are looking to cut costs anywhere that they can, and public health insurance like Medicaid is on the chopping block due to its high cost and generally poor performance. However, this will leave many citizens without health coverage and, according to some sources, exacerbate economic issues in Tennessee as well. For these reasons, it seems that Medicaid reform should focus on more effective reimbursement for providers, which would ease many of the problems with the program in the area.

In Nashville, one of the biggest problems with Medicaid reimbursement to local hospitals, doctors, and dentists is the fact that Medicaid reimbursement often fails to fully reimburse the medical facilities for their expenditures. Health care providers are often reluctant to treat patients on Medicaid because of the program’s poor track record of fully reimbursing providers for their services (Salaman 2011). This is one of the more serious problems with Medicaid that causes providers to mistrust the system and hesitate to provide appropriate care to people who rely on Medicaid.

While it is important for lawmakers to consider the inadequacy of Medicaid in reimbursement, the current economic climate creates difficulty for expanding government services. According to a report by Families USA, efforts by Congress to cut costs by cutting Medicaid could prove disastrous for families in Nashville (Lemmon, 2011). In addition to the first order effect of hurting the business of healthcare providers, the cuts could further cause hesitation on the part of providers and serve only to exacerbate the issue for Nashville families, doctors, and the economy. The program has already faced trouble. In 2010, Tennessee was forced to remove 100,000 people from coverage by Medicaid, leaving many of those families unable to attain basic health care (Wadwhani 2010).

This seems to be a derailment from the urging of constituents to examine the problem of reimbursement in order to service problem areas and improve the system. Providers have long considered Medicaid among the worst sources of reimbursement, and have constantly urged Congress to provide a better solution (Arnold 2010). It is clear that the problems that stem from poor reimbursement policies do not only affect the business of the doctors, but the health and welfare of the citizens who utilize Medicaid as well.

The problems with Medicaid run deep, but it seems that the main priority should come in the form of proper reimbursement for health care providers. As a Health Information Manager, it would be my responsibility to ensure that accurate and timely reports would be made. Reimbursement can only be delivered appropriately if expenditures are accurately reported. Ensuring that accuracy is maintained is the first step to fixing the problem. Medicaid, after all, can not reimburse based on poor information.

References

Arnold, Scott “Congress Urged to Address Medicaid Reimbursement” News Channel Five: Nashville. Retrieved June 19, 2011 from http://www.newschannel5.com/story/13565353/medicare-meltdown-in-tennessee?redirected=true

Lemmon, Dave “House Republican Proposals Cutting Medicaid Could Devastate Tennessee’s Seniors and People with Disabilities” Families USA. Retrieved June 19, 2011 from http://www.familiesusa.org/resources/newsroom/press-releases/2011-press-releases/medicaid-long-term-care-tn.html

Salaman, Maureen “Some Dentists Reluctant to Tread Kids on Medicaid” News Channel Five: Nashville. Retrieved June 19, 2011 from http://www.newschannel5.com/story/14696637/some-dentists-reluctant-to-treat  -kids-on-medicaid-study

Wadhwani, Anita “Tennessee Removes About 100,000 People from Medicaid Rolls” Kaiser Health News. Retrieved on June 19, 2011 from http://www.kaiserhealthnews.org/Stories/2010/April/08/TennCare.aspx