Health Care

Pediatricians might drop Medicaid patients because of KanCare billing change

More doctors take Medicare in Missouri than in Kansas

Missouri ranked sixth in the nation in percent of doctors taking all Medicare patients while Kansas ranked 48th in a recent survey that underlines the importance of consumers making sure their doctors are covered before choosing a plan.
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Missouri ranked sixth in the nation in percent of doctors taking all Medicare patients while Kansas ranked 48th in a recent survey that underlines the importance of consumers making sure their doctors are covered before choosing a plan.

Kansas pediatricians say it was already hard to make a living seeing Medicaid patients, and a billing change that went into effect Nov. 1 is making it even harder.

Pediatricians say they are now often paid significantly less when they see kids on Kansas Medicaid — or KanCare — although the state says that wasn’t the intention.

Melissa Hudelson, the executive director of the Kansas chapter of the American Academy of Pediatrics, said one pediatrician told her that payments for checkups for 1-month-olds fell from $70 to $26.

“That’s a ridiculous amount to pay a physician for an office visit,” Hudelson said. “I pay that to get my toenails painted.”

Doctors who were already frustrated with reimbursements that don’t keep up with their costs are considering cutting back on the number of Medicaid patients they see, she said.

“If we can’t pay these providers an amount that they can actually afford to keep the lights on, then a lot of them that are seeing 20 to 30 percent Medicaid children, they’re going to have to stop and think if they can keep doing that,” Hudelson said. “Then you’re looking at an access-to-care issue for these kids.”

Pediatricians voiced their displeasure about the billing change Friday in Topeka at a meeting of the KanCare Advisory Council, which includes lawmakers.

The change forces them to submit 12 separate codes for a bundle of checkup services that used to be a single code. Because they don’t always perform all 12 services, they’re taking a pay cut.

Jon Hamdorf, the state’s Medicaid director, said the 12 formerly bundled services were separated out so the state would have better tracking data to see who was receiving which services and to allow other providers like county health departments that provide just one of the services to bill for it.

“In the bundled model, it was all or nothing and we couldn’t report on the individual services and track if the frequency of these services were increasing or decreasing,” Hamdorf said through an email from a state spokesman. “There is not a limit on billing these services and if they are all billed for, the reimbursement will be the same as the bundled rate.”

But Hudelson said pediatricians previously used the bundled code for checkups for kids of all ages, even though some of the 12 services can’t be done until they’ve grown a bit. For example, evaluations for developmental disabilities can’t be done until they’ve reached an age when they should be hitting certain developmental milestones, and hearing and vision screenings can’t be done until they can communicate what they’re seeing and hearing.

About 266,000 children in Kansas are covered by Medicaid or a supplemental program called CHIP. That’s almost 40 percent of all kids in the state, so Hudelson said most pediatricians can’t stop taking Medicaid patients completely. But in affluent parts of the state like Johnson County some can, and doctors in other areas can scale back.

Hudelson said more doctors would have been willing to absorb the billing change if Kansas’ base Medicaid rates for well-child visits were higher. But they were already lower than what surrounding states pay for kids on Medicaid and lower than what Medicare pays for adult visits.

Hamdorf said he’s sympathetic to those concerns. But he won’t be in the job much longer, as Democrat Laura Kelly will take over as governor next month for his boss, Republican Jeff Colyer.

“We agree that the current rate could be increased,” Hamdorf said, “and we are evaluating what impact that would have to the (state) budget and will be presenting that to the new administration for consideration.”

Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.

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