Self-Pay Revenue Management

2 min read

The BIG Problem CFOs Are Missing

January 17, 2019 - 2:49 PM

By Kaylee Riddle and Audrey Cooper 

Healthcare Chief Financial Officers strategize with their Revenue Cycle teams to create projects that help healthcare organizations meet financial goals. When prioritizing initiatives, CFO’s look for projects that have high financial return and low resource impact to the organization.  Identifying the best projects can be difficult as the CFO’s are reliant on middle management’s ability to capture and report areas of concern.  

After corresponding with a former CFO of multiple well-known healthcare organizations, it became apparent that CFOs are not informed of a very serious financial problem facing health centers: the deficit of Medicaid payments caused by retroactive Medicaid. Federally Qualified Health Centers lose hundreds of thousands of dollars a year, and financial officers don’t even realize it. A lot of them don’t know that there’s a simple solution for this problem.  

The Problem 

Dealing with Medicaid is a very difficult process. Firstly, the enrollment process can take between 45-60 days. Patients have to provide lots of personal information and  provide proof of income. If they’re employed, they’re required to have a form completed by their HR department. This process takes time. After a patent is covered by Medicaid, they could be dropped for several reasons, and then picked up again. There constant questions regarding coverage with Medicaid. This creates gaps of coverage and payment from Medicaid.  

The gaps come from services provided before patients were covered by Medicaid, or during a duration of time when Medicaid dropped the individual. Without billers spending hours and hours of combing through information to find these payment gaps and then rebill Medicaid, millions of covered services remain unpaid.  A health clinic will not waste resources in looking for missing payments because it is too timely.  

The Solution 

Emerald AR Systems has created a solution to find and bill the missing payments from Medicaid. Emerald’s Claim Miner service, catches retroactive Medicaid opportunities and turns them into cash! The program searches through self-pay encounters and identifies retrograde Medicaid coverage throughout its timely filing life-span. When a service becomes eligible for retrograde reimbursement, Health center billers are immediately notified and given all the billing information. Now Medicaid can reimburse the clinic and the debt is paid.  

Don’t miss any more Medicaid payment opportunities. Call is at 866-299-8383 ext 2 to get started.

Written by Acooper32

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