Is Accepting Medicaid Right For Your Office?

Real World Insights from AADOM Authors - Nicole Hartshorn

Has your office considered taking Medicaid? Chances are you’ve heard a lot of feedback about why you should not take it. Reasons like low reimbursement, dealing with another government agency, and terrible patient compliance are just a few.

While I cannot deny these are definitely things to consider, I look at it a bit differently, with the glass half full! Here are three reasons you should consider taking Medicaid if you aren’t already:

Simplicity of Billing

One massive advantage of Medicaid is the simplicity of billing. Medicaid is a piece of cake compared to PPOs. For instance, they have a list of covered services, and quite simply, if it is not on that list, it is not covered. This eliminates any guesswork in treatment planning. Any non-covered services can usually be billed to the patient as long as you have consent before the procedure. This is something each of your practices is likely already doing.

From a pediatric dentistry perspective, there is very little insurance verification time involved. All you need to know is if they’re eligible. There are no maximums, deductibles, or downgrades to worry about (at least not in Colorado). Even on an adult patient, all you really need to know is if they’re eligible and how much maximum they’ve used. Again, this is something with which you are already familiar. It takes seconds to gain the small amount of information you need instead of ten-plus minutes on other insurance coverages.

Considering the Reimbursement Rates and Overhead Costs

Medicaid is notorious for low reimbursement rates, which are often lower than most PPOs. This is the biggest hurdle you will jump through when deciding if Medicaid suits your office. We deserve to be paid fairly for what we do. With Medicaid, you will not pay your team members to research claims or benefit coverage. This allows your team to spend their time on other things. They will be working less to collect money. Time is money, my friends!

If you sign up for EFTs, you will have a steady and predictable income source. While we have seen the insurance industry get better at this over the last decade, Medicaid has always been great at it. Even during the pandemic, while many insurance industries suffered staffing shortages and claim delays, Medicaid did not. Weekly predictable deposits and not having to work as hard to collect those dollars can help justify the lower reimbursement rates.

Serving the Community

Last but certainly not least, serving the community is a huge advantage of accepting Medicaid. Depending on your community, there may not be many Medicaid providers in your area. This can leave a huge gap in the access to care that many Americans need. Especially in pediatric dentistry, which I am very passionate about.

We must take care of our nation’s children; they are our future! Serving our community’s children is what we do, and we love doing it! For our practice, this is why we began accepting Medicaid more than 40 years ago and never looked back.

All in all, some challenges come with accepting Medicaid, and only you know what is right for your office. With so many opinions out there about why you shouldn’t accept it, I wanted to offer you another perspective of why you should.

Do not believe all the bad things you hear. Yes, there are rules to follow with Medicaid, but they are crystal clear and easy to follow. The simplicity of covered services leads to quick and easy claim turnaround. Very minimal staffing resources are required for any verifications or claim follow-up. All these reasons make it easier to work with the lower reimbursement rates. Plus, we’re doing a great thing for our community.

If you have any questions or comments, please feel free to reach out to me at

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About the Author

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Nicole Hartshorn is a seasoned Dental Practice Manager with 19 years of experience in the dental industry. She started as an assistant in high school and has worked just about every position in the office over the years. Nicole specializes in managing multi-site teams and fostering leadership training opportunities. Her success is rooted in building quality relationships with team members. She is the Chapter President for the Denver area AADOM Chapter.

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