02/11/2026
I have learned a few things recently that need to be shared!
Medicaid RAE's have been terminating contracts "without cause" and there is ZERO appeal option. The answer is even your EIN can NEVER enroll again.
Things I continue to teach & preach -- make sure you have all of your ducks in a row, make sure your checkboxes are checked, for your own charts but ALSO the other clients / providers under your license.
Even if there is another licensed provider under your EIN - its still YOUR business and YOU get dinged, not them.
This is YOUR baby. Dont let someone else tell you how to run it. If you know something is wrong - or - if you dont want to do XYZ - then put your foot down. They wont get in trouble, you will. Dont let them run over you or tell YOU how they are going to do it.
This is YOUR baby. Dont let someone else tell you "well I hope this is good enough." Make sure you create a policy and process to ensure you are compliant with insurance requirements.
I promise you, Medicaid will not care if you tell them "Well, I encouraged them to do this and they didnt 🤷♀️ " Insurance will tell you, you signed a contract promising you would do XYZ. IF you don't do the things, if you know its not done, then DONT send it to insurance. You wont be in trouble since you didn't ask for reimbursement for a non-compliant appointment/chart. If you did send it- they will respond with, welp! You broke the contract, rules and requirements. Sometimes its as small as "do better next time" but if you do it enough - then you are opening yourself up to a bigger liability and risk. Like this provider that is now terminated without any option to appeal the decision. Zero recourse.
As a HUGE Medicaid "pusher" I do not say this, in any way, as a scare tactic. To the contrary - to really remind you guys - that I dont say these things just to say them or be picky or a "hard ass" -- I share this information with providers constantly so that you can make sure you do it right from the start! As long as you are doing it right - then you have nothing to worry about. But, those that are not - it really is actionable.
👏 This. Is. Your. Baby. 👏
Protect it. Ensure you are compliant with the insurance requirements.
If you dont know what that means-- shoot us a message! 💬💬 We can help!
