Finding Yesterday’s Revenue

Retroactive Coverages

Did you know that Medicaid coverage can start retroactively up to 3-months from the date that the Medicaid enrollee applied for coverage? Depending upon the state eligibility requirements, you could be transporting an uninsured patient today who may apply and receive Medicaid coverage retroactively.

Why is this important to know? If your medical service does not bill a patient for an emergency service due to tax subsidization, membership program or ordinance, your organization could be missing billing opportunities. You could also be leaving money on the table if you have an aggressive collections process and your outsourced collection agency is not screening for this type of coverage.

As a best practice, there are several steps that an emergency medical services provider should implement to uncover when/if a patient has applied for insurance coverage but has not yet received approval:

Verify

Ask the question to the patient, or authorized representative, if they have applied for any insurance coverage, but have not received approval. This can be asked at time of transport by updating your EMR, or run report, to facilitate this questioning. You can also implement this in the billing department, or in the early out process. These accounts should be noted to follow-up to verify once patient’s application is processed.

Ongoing Scrubbing

Continuously checking self-pay accounts each month against State and Federal Medicaid will uncover retroactive Medicaid and disability, if your demographics are correct.  In many cases, medical facilities find the process to be labor intensive and choose to utilize vendor partners to assist with the process. As an example, my organization utilizes the company sponsoring this blog, Solutions Group, to assist in uncovering retro-active insurance on our self-pay accounts.

 

As a result of retroactively scrubbing your self-pay accounts, you will be pleasantly surprised at the amount of money you can collect by implementing this simple solution.  Your billing office or agency should pursue collection efforts for every third party source available before billing the patient. It is always easier to collect from a third party source, but most importantly, it is delivering excellent customer service to the patients you serve.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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