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make capturing every Medicaid dollar your goal

 
Category: Case Study
Vertical: Healthcare Billing
Est. Read Time: 3 min
simplify patient billing
 
 

Do you want more efficiency within your organization?

Have you been operating with an understaffed department? Are your 60-120-day buckets getting larger and larger? Do you have way too many manual processes? Were you nodding at any of these questions as you were reading them? 

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Are you collecting social security numbers?

For medical care providers, it is essential to have accurate and up-to-date information for identification purposes----

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Creating a better Healthcare billing system

As a healthcare provider, you want to provide the best possible service to your patients; this includes medical billing. Not only should your patient billing processes be easy to follow, it is imperative that they are also accurate and efficient to ensure sustained financial health for your practice. 

Medical Billing Vendors - How to keep them accountable

In many cases, healthcare providers utilize vendors to take care of the medical billing so that healthcare personnel can dedicate more of their time to patients and medical procedures. Ideally, the medical billing vendor you select understands the services you provide, promotes best in class billing processes, and knows how to recover funds quickly. 

Although medical billing vendors are typically highly vetted vendors, in some instances, you will still end up with sub par medical billing services -- so what happens if you have chosen the wrong medical billing vendor? In this case study, we look at how Emerald dealt with a large, multi-physician group (who will remain anonymous due to the sensitive nature of the subject) that was experiencing problems with their outsourced medical billing vendor.

The Medical Group had been working with this vendor for just over two years but discovered that the vendor had made several billing errors, one of which involved insurance verification. Patients would call the Medical Group's collection agency to advise that they were actually eligible for Medicaid. The vendor assured the Medical Group that it was able to capture all Medicaid eligibility. The Medicaid audit the Medical Group finally undertook showed otherwise.

Emerald ran accounts through its Claim Miner system to identify missed Medicaid. The Medical Group was shocked by the findings. Emerald found that $567,888.08 had not been billed to Medicaid and that 4,343 patients had not been properly identified as Medicaid eligible. The Medical Group was not just leaking revenue; it was hemorrhaging money! 

The Medical Group enlisted Emerald's assistance. Not only did Emerald help the Medical Group recover the substantial amount of missed Medicaid dollars, but it also helped the Medical Group to end its existing arrangement with the sub par medical billing vendor. Emerald also worked with the Medical Group to identify all self-pay accounts and accounts that should and could be properly written off as bad debt for timely filing adjustments.

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Patients Accounts were Scanned

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Patients eligible with Medicaid

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Amount of Medicaid Dollars Not Billed

 

It really does pay to engage a vendor who has embraced the current advances in technology and employed automation in a way that ensures accuracy and efficiency in your billing processes. Now more than ever -- with increasing patient billing volumes and the resulting medical billing costs -- healthcare providers who incorporate innovation in their patient billing procedures gain the fiscal advantage. 

Working with the Medical Group, Emerald was able to save a potentially disastrous situation, and help the Medical Group quickly adapt to the changing competitive landscape by adopting beneficial technology and automated processes to ensure it won't have to deal with missing Medicaid billing again. 

 

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Understanding Medicaid Challenges

Your front office staff probably works hard to verify the patient’s insurance at the time of service and may even assist self-pay patients with enrolling for Medicaid, but what happens after checkout? A time-consuming process of continually monitoring self-pay visits and patient Medicaid enrollment status. This daunting manual task  results in many billable opportunities going unnoticed and written off as bad debt or timely filing adjustments.  

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