Top 5 Medicaid Billing Issues and How to Prevent Them

Billing is one of the primary aspects of non-emergency medical transportation (NEMT) businesses. However, Medicaid billing issues and discrepancies continue to create challenges and hurdles for these organizations. 

While NEMT businesses have significantly improved services for Medicaid recipients, getting paid for these trips can be tricky. One of the best ways to deal with this is to know what to expect regarding Medicaid and its billing regulations, difficulties, and ways to prevent billing errors.

This article examines some of the most common Medicaid billing challenges NEMT providers face and offers specific strategies for overcoming them. 

Medicaid Billing Issues 

Over the years, Medicaid has gained tremendous traction in the medical industry. Yet, as Medicaid has evolved, so have its rules and regulations. 

With Medicaid billing, NEMT providers must be cautious and comply with their state’s Medicaid system mandates. It is essential to stay updated with changing rates, regulations, reimbursement rules, and other crucial factors when handling Medicaid billing. 

Business owners should be aware of how payment methods can become stuck in the Medicaid program. Let’s learn about five of these complications in the Medicaid claims and billing processes.

1. Patient Eligibility

Before ensuring a trip, NEMT providers must verify whether the patient is eligible under Medicaid.

As a state and federally-funded medical insurance program, Medicaid will not reimburse for trips if the patients are not beneficiaries.  Depending on the state, broker, or MCO, they may have a database to ensure the customer is covered.

Cross-checking patient eligibility is critical before providing transportation, as you won’t be reimbursed if the person isn’t covered.

2. Incomplete or Inaccurate Documentation

Following the proper documentation and regulations is necessary for a successful claims process and payment. 

After a trip, NEMT operators submit attestation requests to managed care organizations (MCOs) or brokers for approval. The attestation must be accurate, as missing or incorrect information can lead to claim denials or delayed payments. 

NEMT providers must address each error to ensure a smooth attestation process, claim approval, and quick payment. Incorporating NEMT billing software in this mix can allow NEMT providers to experience an accurate and stress-free billing process. 

3. On-time Processing

One significant issue during claim submission is submitting claims within a proper time frame.

Even if the claims accurately present all the information, they can still be denied or result in reduced reimbursement. 

Again, by using NEMT billing software, NEMT providers can adhere to their state’s Medicaid deadlines and receive timely payments. 

4. Improper Authorization 

Improper or incomplete authorization for services can also lead to claims denial.

NEMT providers should seek prior authorization from Medicaid, as is the typical procedure in many states. 

Pre-authorization reduces the risk of miscommunication and claims denial, ensuring timely claims acceptance and payment rollout. 

5. Delay in Payment

While NEMT providers can do everything right, their payments may still be delayed.

Medicaid reimbursement is often a time-consuming process that hinders cash flow. 

NEMT providers can expand their expertise to private pay bookings to maintain an alternate cash flow channel, even when primary cash flow is restricted or delayed.

What’s the easiest way to handle Medicaid billing issues?

In addition to the suggestions we’ve provided above, the right NEMT software can quickly solve Medicaid billing challenges.

NEMT providers can quickly enhance their process by incorporating NEMT software into their business. NEMT billing software helps providers streamline fleet operations, oversee driver and vehicle allocation, and manage their finances. 

The right software can optimize the billing processes, reduce the risk of manual errors, stay updated with federal and state medical compliance regulations, track patients’ bookings and details, and maintain consistency in tracking information. 

Tobi provides solutions to the everyday challenges NEMT providers face.

Tobi’s NEMT software improves the claim submission process by submitting attestations electronically. Providers can seamlessly submit and monitor claim statuses and choose between manual or automatic submissions, drastically reducing the chances of late submissions. 

Are you curious how Tobi can help you run your NEMT operations more efficiently? Request a demo for a free 30-day trial and experience how Tobi makes your business better at every turn.