Here's some backstory: I recently had two interesting encounters with higher-ups in the payment solutions industry. One was employed directly with a payer; the other by a third-party company which sells its services to payers. (I'm omitting names in the interests of protecting the...guilty?)

I came away with a few key conclusions:

• Widespread use of virtual cards means that The Powers That Be are concluding that this is a popular method of payment. They are NOT considering that these statistics might have a different interpretation.

Such as ... I don't know... possibly that providers are unaware of their options & rights under the law?

• The amount of income lost to virtual cards is staggering. The payer, one of the largest, reported that over $1 billion was redeemed in 2022 via virtual cards. And that 90% of the professionals who charge these out are individual practitioners or small groups. In other words...YOU.

If we assume that the average merchant fee is 3%, then this was $30

million of healthcare professionals' income being spent on merchant fees.

And that was only one insurance company!

Who gets this money? Whoever it is...it's not you.

• Big Brother is watching us. I learned that these systems use AI, programmed to flag ANY redemption of virtual cards. If you opt out of virtual cards with payer A, but accept one later from payer B, then you will be reset to virtual cards for ALL payers handled by that intermediary.

If I can get enough of a response, I will aggregate the comments and pass them to the executive. I can't promise any changes (or even expect them!). But perhaps we can challenge their denial, just a bit? I will certainly share as much as I can of what occurs during the meeting, and what I find out.

This should be interesting!

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Your Medicaid clients may be losing their coverage! It's not an April Fools joke...

As of April 1, states began re-examining their Medicaid enrollees to see if they continue to qualify for coverage.

Periodic re-examination of Medicaid eligibility was a pre-pandemic fact of life, but was suspended by the feds during the public health emergency. Depending on the state, many additional people qualified for Medicaid and/or CHIP between 2020-2023 due to the economic downturns associated with COVID. Now, they risk losing their coverage. CMS estimates about 15 million people are at risk.

The exact details will wary according to your state's Medicaid regulations.

What do I need to do?

VERIFY your client's Medicaid eligibility every session - at least for the next few months. If they don't receive notification from the state (for instance, if they moved and didn't update their information), then they can't let you know they are no longer enrolled - they won't know either!

If you verify prior to service and find that their eligibility is lapsed, you will have time to make financial arrangements with your client - and will not be blindsided by denials.

Learn more here! This handout is written in plain English, and may be useful to give to any client(s) you think might be affected. It addresses the options they have.

Have you ever wished for a biller who wouldn't charge you a percentage of every dollar you make? Someone you could count on when you get stuck?

I'm Susan Frager, Your Billing Buddy. I've spent 25 years as a mental health biller for practices in 23 states - I can help YOU, too!

You CAN bill and manage your practice on your own...with a little help. You do the easy part - keep as much money as you can. Then when the going gets rough...Don't give up! Schedule a consultation.

You don't have to go it alone.

susan@yourbillingbuddy.com

(360) 628-8612

Need help with billing, claims, credentialing, or practice management...?

1420 Marvin Rd NE # C464

Lacey, WA 98516

(360) 628-8612

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