Medicaid

[dentite24]

As a GP are you allowed to only except Medicaid for emergency exams and extractions? For instance if patient on regular schedule cancels and Medicaid patients calls or walks in, this would be a way to fill schedule and provide meaningful service. Or, scheduled full mouth ext/alveoloplasty -> referral to office that accepts Medicaid dentures. I've heard of offices doing this... it can't be illegal right?
Can I work at a Medicaid office as a temp but don’t take it at my regular office?
Is there any written rules on this stuff or is it all hear-say?

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[allDAT]

The headache associated with accepting Medicaid wouldn’t be worth it for a limited scope a practice. Honestly, if you’re an honest dentist it’s not worth accepting in a private setting. If you’re determined to treat patients on Medicaid it’s best to work at an FQHC where they’re paid per encounter. Good luck.

 

[redchesus]

I think there are some pretty strict rules when you start accepting Medicaid patients, I wouldn't be surprised if they had rules in place against this.

 

[maruprime]

This is 100% illegal. If you only accept Medicaid patients for limited exam and extractions, then you must limit your practice of all patients on all insurances to just limited exam and extractions. You cannot discriminate treatment based on different insurances. To clarify, if you perform crown, filling, dentures, root canals for PPOs such as delta dental/cigna/metlife patients, then you must offer these services for medicaid patients too. You'll hear about ways to deny treatment such as scheduling patients 3 months out, or saying "sorry this MOD filling is too complicated, I have to refer you to a prosthodontist." It is completely legal and ethical to refer patients when you do not feel comfortable performing treatment, and this is the tactic that offices use and abuse to NOT perform low-paying procedures for patients and referring them to different offices. You may have 99 dental friends who get away with this, but you may be the 100th dentist who gets the random medicaid audit.

For your 2nd question: it is completely legal to accept medicaid patients at one office, and not accept it at another office. When you sign up for insurance, you sign up your NPI, your name, and your office location. So 1 doctor who works in 3 locations may choose to only accept medicaid at 1 location. That is normal in California.

Last questions: when you sign up for medicaid, you will receive a 60 page booklet in the mail with the rules written. There are auditors who come to your office to make sure you follow the rules, this is the same for all PPOs too.

 

[Beauchemin13]

There is an office down the road from me that does just that. It is an implant heavy office that also does extractions for Medicaid but nothing else. I am also a heavy Medicaid office and it works really well for me because if I don’t feel comfortable doing something I just refer to him. I’m not sure if he does it for financial gain or just to help the community but either way it works great for me.

 

[dentite24]

This is 100% illegal. If you only accept Medicaid patients for limited exam and extractions, then you must limit your practice of all patients on all insurances to just limited exam and extractions. You cannot discriminate treatment based on different insurances. To clarify, if you perform crown, filling, dentures, root canals for PPOs such as delta dental/cigna/metlife patients, then you must offer these services for medicaid patients too. You'll hear about ways to deny treatment such as scheduling patients 3 months out, or saying "sorry this MOD filling is too complicated, I have to refer you to a prosthodontist." It is completely legal and ethical to refer patients when you do not feel comfortable performing treatment, and this is the tactic that offices use and abuse to NOT perform low-paying procedures for patients and referring them to different offices. You may have 99 dental friends who get away with this, but you may be the 100th dentist who gets the random medicaid audit.

For your 2nd question: it is completely legal to accept medicaid patients at one office, and not accept it at another office. When you sign up for insurance, you sign up your NPI, your name, and your office location. So 1 doctor who works in 3 locations may choose to only accept medicaid at 1 location. That is normal in California.

Last questions: when you sign up for medicaid, you will receive a 60 page booklet in the mail with the rules written. There are auditors who come to your office to make sure you follow the rules, this is the same for all PPOs too.

Gotcha! This was probably the clearest answer I've received on this subject.