Adding Medicaid Services – Maintaining Control of Your Profits and Patient Roster

Jun 28, 2023

In 2022, the Missouri legislature passed the historic rate increase for dental Medicaid reimbursement, making MO HealthNet comparable to, and in some cases more profitable than, private insurers.

This comes at a time when Missouri’s Medicaid population is severely underserved. Thirty-six out of 114 counties are without a single dental Medicaid provider and only 3 in 10 Missouri dentists are credentialed to provide Medicaid services – about half of whom are actually treating Medicaid patients.

The rate increase and renewed awareness in Medicaid provider shortfalls have sparked new interest in accepting Medicaid patients. However, many questions surrounding profitability and patient volumes remain.

How Do the New Rates Stack Up?

Use the Dental Provider Manual (SECTION 19-PROCEDURE CODES) to explore the dental Medicaid procedure codes and their associated fees for billing.

You can also use the Dental Fee Schedule to find the associated fees for procedure codes. This tool will always show the most up-to-date information.

  • Once you’ve opened this page, select ‘Dental Services’ in the column on the left. Then scroll down to the purple ‘Search Options’ box and select the ‘Proc Code’ radial button.
  • Put the procedure code from the Dental Provider Manual in the box and choose ‘Go’. This search will return the fee amount that you can bill for that procedure.

Please note: Not all codes increased under the new bill. Specialists should take care to review the fee schedule closely as many of these services were not part of the reimbursement rate increase.

Balancing Your Patient Roster

One of the most common misconceptions about treating Medicaid patients is that you must take every Medicaid patient who walks through your doors. For providers who already have a decent patient load, adding Medicaid services can feel like an overwhelming venture.

The good news: You don’t have to see every Medicaid patient. You have control over the kind and number of patients you see.

There are many ways to limit your Medicaid patient volumes to help maintain a balanced patient roster.

  • Percentage: Dedicate a certain percentage of your patient load to Medicaid. 10%, 20%, 30%. The choice is yours.
  • Age: Prefer to focus on pediatric patients? Passionate about helping the elderly? You can set your own parameters on the Medicaid patients treated at your practice.
  • Referring Physician: For those who have established relationships with physicians, or work in a multi-specialty medical building, it may make sense to limit your Medicaid patients to those sent by a referring physician.
  • Day of the Week: Choose a Medicaid day (or days) to regulate the number of new Medicaid patients you bring on.
    • Take care not to limit patients by time windows (for example: only 9:00am to 11:00pm) as this is considered discrimination.
  • Care Plan: You do not have to credential with all care plans. If desired, you can accept Fee-For-Service or any combination of the Managed Care Plans. Learn more about the different plans in our Medicaid Mini – Meet Your Payors.

No matter how you choose to manage your Medicaid patient volume, be sure your practice’s criteria are clearly defined in your Medicaid policy. And that the care plans with whom you participate are clearly displayed.


Preventing No-Shows

Welcoming any new patient comes with a certain amount of risk. Leading with compassion and making every effort to build a relationship with your patients, especially those with Medicaid, will help them feel safe and make your clinic their dental home.

MO HealthNet also provides non-emergency medical transportation that can be utilized for dental appointments. Make sure your Medicaid patients are aware of this service!

Ready to Take the Next Step?

Check out our Medicaid Mini – Credentialing 101 and our Credentialing 101 blog post for the step-by-step process to enroll as a dental Medicaid provider.

Or contact your Medicaid Mentor, Jessica Emmerich, for questions and additional support. You can reach her via email or phone call and text at (573) 536-2474.