You have done everything in your power to reduce expenses and increase revenue for your practice. You have sharpened your handling of claims; now you file every day and regularly appeal underpaid and rejected claims. Your staff has been trained to interact with newly insured patients and the collection of patient co-pays is improving. You are working hard to find and close every tiny revenue gap possible because at a profit margin of only 1% to 2%, every penny counts. Yet, there is one revenue stream that you may not know about. Actually it’s more like a bubbling brook and it’s running right under your feet; retroactive Medicaid payments.
This can be a robust source of recovered revenue for your practice. We know it’s there, but no one else seems to have discovered it. We are the only collections agency in the country that captures this lost Medicaid revenue as a matter of practice. Here’s the story.
The ACA expanded Medicaid eligibility for adults and children by allowing temporary access to Medicaid coverage so that patients can easily enroll or renew their coverage. The Kaiser Family Foundation (KFF) website posts a good review of this issue and reports that access is obtained
(hyperlink:http://kff.org/health-reform/issue-brief/the-affordable-care-acts-impact-on-medicaid-eligibility-enrollment-and-benefits-for-people-with-disabilities) “by conducting presumptive eligibility determinations while a full application is in process. As of January 2015, 28 states authorize entities to conduct presumptive eligibility (hyperlink:http://kff.org/health-reform/issue-brief/medicaid-moving-forward/) determinations for children, pregnant women, parents, or other adults.”
Ok, so you can enroll patients in Medicaid. How does that connect to new revenue? If you are enrolling patients in Medicaid at the time of treatment, you can bill for any services delivered to them during the previous 90 days. The legislation says, “Retroactive Medicaid eligibility may be available to a Medicaid applicant who did not apply for assistance until after they received care, either because they were unaware of Medicaid or because the nature of their illness prevented the filing of an application. Retroactive eligibility is available when there is an unpaid medical bill for a service provided for three full months immediately before the month of application providing the individual meets all the eligibility criteria.”
How many patients have you enrolled in Medicaid since the ACA was enacted? How many claims do you think can be filed for services rendered during the previous 90 days? For one client we found 300 claims a month, the majority of them Medicaid, to rebill, at an average value of $100 per claim. The practice made good use of that newly discovered, previously lost $300,000 and we imagine you could too.
(We know we are tooting our own horn here, but since we are the only collections agency in the country billing for retroactive Medicaid, we are the only example to use!) When you use Emerald A/R as a collections agency, we scan for eligibility on an ongoing basis to find out who is covered and who is not. In other words, what patients are not covered today, but are eligible for Medicaid, and when enrolled can be billed for services rendered during the last 90 days?
The Emerald A/R system proactively scans your patient accounts for eligibility. We are instantly notified if anything changes in a patient’s insurance eligibility. We know when they are paying their premiums for coverage, and when that has lapsed. We can renew their coverage so you don’t lose those billings.
Not only do we shore up your Medicaid payments, we also relieve the insurance pressure on your front office staff. Newly insured patients take a lot of your staff time. They need to understand how insurance works. They need help understanding the bills they receive after insurance coverage, (and countering the mythical belief that insurance means no bills at all!) A confrontational conversation can cost you a patient, or even a good staff person. We assume the role hyperlink to EBO of your patient pay function. We seamlessly interact with your patients, educating them, compassionately explaining their insurance to them and helping them submit payments. We handle incoming and outgoing patient pay phone calls and enroll them online so we can file for services provided during that 90 day retro window.
- We know your patients’ insurance coverage, deductible and copay.
- We can email their coverage to them.
- We help them to understand their medical bills.
- We make sure your practice includes the right information on Medicaid coverage in all the right places: your website, the HIPAA form, patient registration form and more.
The bottom line isn’t just dollars and cents any more, as you well know. The bottom line today includes patient retention. If patient confusion about insurance coverage can be resolved kindly, they are less apt to blame you, less apt to shop for another provider, and more apt to stay with your practice.
It certainly is a daily battle, but we see no reason why you should be drowning in lost dollars. We know where that babbling brook of Medicaid retro billing is, and we think you should be swimming in those receivables, but we see no reason why you should be drowning in lost dollars. We know where that babbling brook of Medicaid retro billing is, and we think you should be swimming in those receivables.