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Medicaid Emergency Department Reimbursement Rates

Medicare Reimbursement by StateEver wondered how much doctors get paid for taking care of Medicaid patients?

I came across some data compiled for Medicaid reimbursement for emergency department visits from 2011. You can download the .pdf file here. There was also some information from 2008 and the rates hadn’t changed much.

For each category, the payments are broken down into CPT codes depending on intensity of service.
A 99281 code is essentially a nurse visit – no doctor involvement and hardly ever used
A 99282 is a simple case with no or minimal physical exam – such as an asymptomatic patient needing a medication refill or perhaps a simple sunburn.
A 99283 is a straightforward case with little medical decisionmaking such as an ear infection, a strep throat, or a UTI
A 99284 case requires more decisionmaking with some lab tests being ordered. Perhaps a patient with a sprained ankle, a patient with minor abdominal pain, or a patient with asthma needing nebulizer treatments.
A 99285 is a case requiring high medical decisionmaking, multiple tests, and likely hospital admission. Consider cardiac chest pain, severe abdominal pain, suicidal patients, patients with low blood pressure, etc
A 99291 is a “critical care” code, meaning that the patients are in danger of dying or having severe health issues. Consider patients requiring CPR, multiple drug overdoses, uncontrolled psychiatric patients, patients with arrhythmias, etc.
Finally 99292 is an “extended critical care code” meaning that if a doctor spends more than 90 minutes stabilizing a patient, then the doctor gets paid this amount in addition to the 99291 amount.

What does this data show you?

Based on their payments to physicians, New York and New Jersey seem to put very little value on the lives of their citizens. They’ll pay doctors as little as $58 to save your life and spend up to an hour and a half keeping you alive. Malpractice insurance costs more than that. Hell, parking your car in a garage in the Greater NY area to go to work in the hospital costs more than that. Rhode Island is even worse. It pays emergency physicians a whopping $29 to provide up to 90 minutes of critical care. Michigan and Wisconsin are also on the list of pathetic payors.

When patients who get their new Medicaid “insurance” cards under Obamacare wonder why they can’t find anyone to provide them care, the fact that many states pay doctors less than the cost of caring for Medicaid patients would be one of the reasons for this lack of access.

Remember: Healthcare insurance doesn’t guarantee you access to medical care any more than automobile insurance guarantees you access to a car.

7 comments

  1. WC- I just read an article that shows the bankruptcy rate for financial difficulty versus the crap term “medical bankruptcy” is no different statistically in…wait for it…Massachusetts with RomneyCare!!!
    I keep telling the left-minded thinkers the same thing you(and I) are saying about access. Having health insurance does not guarantee that you will not suffer financially…but their emotions continue to cloud their thinking and all is well because…Obamacare.
    They do not realize that the people being insured by Obamacare are people who ALREADY had insurance and that those without still cannot afford to be insured. Medicaid swells, assets can be seized– and they have no clue!!

    • Right DefendUSA, if I were to buy the lowest priced insurance policy that I could find, I would be spending at least 3 times my annual income per year. Where does that make sense? Only in NObamma Care.

      Fortunately, I am a veteran. According to the letter I received from the VA, care of enrolled veterans at Veterans Affairs Medical Centers fulfills the insurance requirement.

      Unless they read the fine print, most medicaid recipients do not understand that their states will recover the costs for providing medical care from their estates, once they die, leaving their heirs with nothing. I read the fine print, and decided not to enroll in medicaid; especially since I was already covered by being enrolled in the VA healthcare system (except the VA does not cover dental work).

  2. It beats what we ER doctors get for treating uninsured patients, which in the majority of cases is nothing. Something is better than nothing.

  3. How does this compare to Medicare reimbursement? Or any idea for say a Blue cross patient?

    And finally, I’m wondering if we have any idea (or could even calculate) what a fair and adequate reimbursement is for each code?

    • Since the reimbursements for all types of insurance vary by state and even by provider, there is no “one size fits all” comparison. As a ballpark, I’d estimate that on average Medicaid pays about 60% of what Medicare pays and about 30-40% of what commercial insurance pays.
      What would be fair reimbursement? Difficult to say. One way to arrive at that number would be to make all payment information available to everyone. Then, with future negotiations, the payments would tend to normalize. Might also consider switching to an hourly reimbursement model which would cut down on a lot of overbilling, but would also have to test such a model to see if there were any unforeseen consequences of doing so.

      • Hello, Dr. WhiteCoat:

        Thank you for your comment about the Medicaid reimbursement rate. I am now working on a project about how to cut the emergency room using for asthma patients (children and adults) with Medicaid as their insurance. As an expert, do you know, overall, how much a hospital at NY can get from the Medicaid reimbursement (including everything) for an emergency Room visiting (asthma attacks) by an asthma patient? A rough estimation will be good enough.

        Thank you very much and have a nice day.

        Yang

  4. FYI…I just had to take my child to the e.r.

    The 99284 alone was $1100
    Basic labs – another $1000
    Ct scan – $3000
    Ct read $200
    Etc…

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