Health Practice Advisors Roundtable Discussions on the Practice of Medicine and Medicare and Medicaid

LocaliQ Admin • November 7, 2019

Illinois Medical Director of Medicaid/Medicare, Dr. Arvind Goyal joined us for a private round table discussion on “The Most Frequently Asked Questions Practitioners have about Medicaid/Medicare Services”.

Dr. Goyal spoke of three primary goals for Illinois Medicaid. Accessibility, quality and cost control. 80% of the Medicaid recipients in Illinois have their benefit provided by a managed care organization. If a medication is approved by the FDA, Medicaid must pay for it. They can however enact preauthorization requirements as they see fit and can delay paying claims until they have determined under what clinical circumstances the medication is appropriate.

1 in 4 Illinois residents now get some form of Medicaid. Dr. Goyal explained that not accepting Medicaid is within a practice’s rights, but added “do you really want to exclude 25% of Illinois patients from seeing you?”

A managed care organization administering the Medicaid benefit is only allowed a profit margin of 15%.

To learn more please call Health Practice Advisors today at 312-270-0732.

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