Self-Pay Revenue Management

2 min read

Why Medicaid’s Not Paying your Health Center

February 21, 2019 - 11:45 AM

There are so many ways that a Medicaid claim can slip through the cracks of everyday hustle and bustle of a fast-paced clinic. Every year each health center misses millions of dollars in Medicaid payments. In fact, Emerald AR Systems has located over $2 million dollars of missed Medicaid for just 1 rural health center! Imagine what you could do with an extra $2 million dollars? There are so many reasons that these payments are missed and not paid by Medicaid.

Missed Documents

Many patients will sign up for Medicaid, spend hours filling out papers, but forget a key document. The patient will send their paperwork in assuming they have completed registration and are now covered by Medicaid. Eventually, the patient may find out they missed a document, but Medicaid doesn’t recognize the services the patient received until they receive the missed document.

Patients Mis-labeled as “Self-Pay”

Some patients assume their eligibility would be denied with Medicaid. When they show up for a visit at a health clinic, they’re labeled as “self-pay”. After their first appointment, they may find they could qualify for Medicaid, so they start the enrollment process.   Medicaid approves their enrollment application, but the patient gets busy with life and forgets to tell the clinic of their recent change in coverage.  Meanwhile, the clinic continues their attempts in collecting the balance. The patient receives lots of patient communication including, calls and statements but continually forgets to follow up.  Then, one day, the patient remembers the bill, calls the clinic communicating their change in coverage but it’s too late. The bill is now denied for coverage and by law the clinic has to write-off the balance.

Dropped Coverage

In order to keep your Medicaid coverage, a patient must update their information periodically with Medicaid. If this information isn’t communicated within a timely manner, Medicaid will drop their coverage.  Once the information is received coverage is reinstated. Unfortunately, the patient may have had services at a Health clinic during that period but the clinic’s not aware of the reinstatement.   

The Solution

Your billing team doesn't have time to manually scan thousands of claims looking for missed Medicaid opportunities. This would distract them from their current workload but there’s a simple solution to this problem. Claim Miner, a proprietary scanning system scans your self-pay backlog on a monthly basis locating missed Medicaid opportunities.  Then, it notifies your billing team with all the information they need to bill Medicaid. No work on your end!

Get a free scan on 2000 accounts FREEBIE

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