Well! Do you know waivers have been increasingly popular due to the expansion of Medicaid under the Affordable act, Section 1115? We must say that the State has better and unique ideas to implement programs by customizing according to the population. But, are revenue cycle management companies updated with the following?
These Medicaid waivers are considered for research as well as demonstration projects , designed specifically to test expanded eligibility and coverage options. But for revenue cycle management companies, healthcare professionals and other healthcare organizations, those depend on revenue payments for services provided, these turn out to be biggest challenge.
It’s not only evident that eligibility rules change and differ state by state but also remain as burden for many revenue cycle management companies and healthcare professionals. The proof of exceptions to Medicaid requirements create hurdles to the front end revenue cycle staff.
What Medicaid Waivers do?
- Medicaid waivers in most of the cases try to impose work requirements mentioning as a condition of Medicaid eligibility.
- Especially, it applies when there is a requirement for Medicaid receivers who has to work for minimum hours in order to receive these benefits that includes job training program or demonstration of job participation while doing a job search.
- Centers for Medicaid and Medicare Services (CMS) have approved similar work requirements in several States whose proposals are pending according to the data.
- Some of the other States had instituted enrollment restrictions. Few States potential Medicaid recipients in order to complete health risk assessment before getting enrolled.
- Following these requirements, CMS has approved Medicaid waivers by also allowing them to use Medicaid funds to render short term inpatient and residential treatment services for the patients enrolled with drug addictions and serious mental illness.
- However revenue cycle management companies and healthcare providers will have to be equipped more and get ready to do more benefits investigation as well as insurance eligibility verification by navigating complicated enrollment procedures to determine if the patient qualifies for the coverage and practice.
- Revenue cycle management companies must be aware of the oncoming duties to verify and thoroughly check the information in the documents, work hours, history and health habits of patients or enrollees prior to submitting the claims.
- Perfect denial management by revenue cycle management companies can revamp healthcare professional’s revenue collection procedures and fit into the new restricted Medicaid and incentive focused plans.
- Bulk billing would be required for entire bundle of services rendered and the revenue reimbursement will be based on the subject to change after weeks or months the services are provided.
How do Revenue cycle management companies upgrade to meet the new challenges?
- Revenue cycle management companies must be up to date on the latest healthcare requirements by also keeping an eye on the team to check if they are well trained to handle and co-operate with the changes in clinical documentation.
- Medical billing, Medical coding, denials management, claim submission and account receivables are crucial factors for a profitable revenue cycle management.
- Remaining involves the data provided to the staff including patient demographic details and document verification, eligibility requirements, care gaps and cost.
- Revenue cycle management companies with expertise and highly equipped technology can adapt to the ongoing changes in Medicaid reimbursement and can relieve healthcare providers from stress and aid them in achieving their ultimate goal, revenue payments.
Is Medicaid Eligibility, a key to revenue cycle management companies?
- For revenue cycle management companies’ effective medical billing process involves determining and documenting patient benefits for Medicaid eligibility without any flaws.
- Revenue reimbursement can be often challenging. Medicaid eligibility is definitely where many healthcare professionals struggle to seek their revenue payments and thus it is an important task for revenue cycle management companies.
- Revenue cycle management companies have been scrutinized for a careful medical billing process and prevention of Medicaid errors that could later on cause a lot of trouble.
- Proper understanding about Medicaid and its rules can take the practice long way and ensure revenue payments for all the services provided.
- More than administrators, it’s important to train about the Medicaid updates and eligibility to the staff to handle better documenting process.
- Verification of benefits, patient’s Medicaid coverage and prior authorization must be managed by revenue cycle management companies and help supplement current operations.
Key Performance Indicators to measure Medicaid Eligibility:
1.The Main Measurement:
- There are several ways to evaluate Medicaid eligibility, but the main measurement that counts is, self-pay account receivables balance.
- The more A/R self-pay balances are definitely a warning sign. If these continue to rise, the enrollment efforts and other revenue reimbursements will definitely fail.
- Prior to data evaluation, make sure if the data is apt and accurate. While reviewing the reports, concentration on right metrics is important.
- Revenue cycle management companies must be aware of certain activities those are counted not only for measuring ratios but also whether to pay for a conversation.
- If the account is considered to be self-pay and later on changed to commercial it would not be considered as conversation. But some insurance companies will consider it as conversation and so discussing it in prior will be always safe.
- These two reports are essential to be received from vendor.
- Placement analysis report
- Activity History report
1.Placement analysis report:
- This particular report should answer the following questions:
- What’s the account received by client based on certain months and what’s the success with the accounts?
- How many patients were rendered the service?
- How many patients had applications overall?
- How many applications were approved by Medicaid?
2.Activity History Report:
- How many self-pay admissions you see in a month?
- How do you classify the service type:
- Emergency or non-emergency?
- How many claims are denied?
Hope you got the required information on Medicaid eligibility. For more suggestions, please comment below. For more queries and updates on healthcare, please subscribe to our blog.