What are the bills provisions for provider reimbursement reforms?
Currently, MassHealth routinely pays providers far below the cost of care. Depending on the service, payments range from 60% to 80% of cost, or less. This underpayment discourages physicians and other providers from accepting MassHealth patients, and leads to cost-shifting, where providers are forced to raise rates charged to private patients to make up for underpayments from MassHealth. The bill proposes moving to a system where MassHealth pays providers using the federal governments Medicare fee schedule. In addition to more closely approximating cost (Medicare is still somewhat below cost for many services), using Medicare will reduce the administrative burden on physicians, hospitals and other providers who will not have to use unique codes and billing forms for MassHealth. Instead they will use the Medicare methods which are standard among health care providers.
Related Questions
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