All posts by marketingrca

Third Party Medicaid Eligibility Company Reveals Newly Expanded Office at Ribbon Cutting

Medicaid Eligibility, Third Party Eligibility

HOUSTON, Jan. 31, 2017 /PRNewswire/ — Third Party Medicaid Eligibility company, Resource Corporation of America (RCA), hosted a Ribbon Cutting Ceremony on Friday to celebrate the grand opening of its new support center and regional office expansion.  One of several regional offices in the country, the RCA Houston office is the largest and is located just minutes from the Texas Medical center, the largest medical complex in the world.

The expansion project began less than a year ago, after the company experienced significant growth from new contracts.  In 2016, RCA hired over 120 employees and the Houston regional office more than quadrupled in size.  Additionally, RCA was recognized and listed on the Houston Chronicle’s Top Workplaces survey.

Resource Corporation of America
Resource Corporation of America

After 23 years of being an industry leader, the privately owned company decided to skip the “growing pains” and made the decision to build out their office knowing it would benefit all parties.  “The need to expand our office was an easy decision and the project began without hesitation,” said Frank Dominguez, Chief Operating Officer for RCA, “RCA’s hospital partners rely on us to provide a high quality service and to be a resource for their facility and their patients.  The additional highly trained staff and larger departments ensure our hospital clients receive the maximum amount of reimbursements.”

The ceremony was attended by employees and partners from both ends of the country and was followed by an open house for clients to tour the building and meet key department managers.

Is it time to hand off Workers’ Compensation claims?

Third Party Eligibility

shutterstock_133357538Every provider across the country knows the time consuming pain that is dealing with Workers’ Compensation claims. Here are the top 3 issues we hear providers say they are having with Workers’ Compensation claims:

Low volume of accounts requiring large knowledge base. Workers’ Comp only accounts for roughly 5% of a provider’s accounts receivable, but since every state has their own set of guidelines, this requires highly trained personnel to handle the claims.

Too much paperwork. Workers’ Comp claims processing is still largely a paper-based process. The provider’s personnel must print out the claim documents and assemble the claim by hand and then package it for mailing. This process consumes a great deal of time.

Follow up is crucial. Without constant follow up to the Workers’ Compensation agencies to ensure they have received the provider’s claims, and that the claims are processed and paid correctly, the provider could lose out big time. This part of the process is another cumbersome step.

These are just a few of the reasons more and more providers are looking for outside help in dealing with their Workers’ Compensation claims.

Neil Boudreaux
Eligibility Expert and Director of Operations

Shouldn’t you have more pending in SSI/SSDI?

Medicaid Eligibility, Third Party Eligibility

One aspect of third-party eligibility that is likely not getting enough attention from your vendor or in-house team is SSI/SSDI reimbursements. This is where we see significantly more at-risk dollars and, when followed through properly, makes up the bulk of conversions recovered for our hospital clients. Based on data we collected firsthand, while SSI/SSDI makes up only about 20-40% of self-pay inventory it averages a whopping 60%-80% of pending dollars, on average. Note that while Medicaid accounts are expected to decrease in expansion states, SSI/SSDI is still an important piece of the overall puzzle, no matter expansion or non expansion. We use those averages as a starting point when we are asked to conduct eligibility performance evaluations.

ssi-charts

Our S.O.A.R. (SSI/SSDI Outreach and Recovery) certified experts have over 22 years of experience handling SSI/SSDI claims. Through consulting and providing services to hundreds of providers in those two decades, we have seen that the following errors occur within the SSI process:

Not knowing where the patient is in the process – This seems silly, but it’s true. A lot of eligibility teams do not continue regular follow-up on SSI accounts. In some states, the SSI/SSDI process can take upwards of 2 years and this causes a misconception that accounts won’t progress for months at a time. However, there are many stages to the timely process and weekly or even biweekly follow-up can help hospitals know where the patient is in the process and also increase the approval odds by ensuring the Social Security Administration receives everything they have requested in a timely manner.

Returning referrals to the hospital due to outside representation – When a patient utilizes an attorney or other outside representation for help with their disability claim, it is often incorrectly assumed by the vendor that communication has been compromised and that they will not get the information they need to continue working the account. Returning those accounts negatively affects your bottom line because there are ways to help the representation and the Social Security office without compromising the patient’s relationship with their representative. Therefore our eligibility best practice rule #1 is to follow-up through reimbursement to the hospital.

Informational Claims (Dummy bills) aren’t being filed in time – Do you know your state’s Medicaid filing deadline? Some states have become savvy and will not pay SSI/SSDI cases if they never receive the bill or an application to protect the dates of service. Your team should be submitting timely claims in order to protect all dates of service for the patient and then rigorously following the account so the hospital can collect in the instance a patient is approved for Medicaid during the SSI/SSDI process. Accounts not filed in time or only sent through a batch filing software could be easily lost forever.

Stopping at mediocre – Often times our SSI/SSDI cases need a little extra attention. This means immediately filing appeals, providing patient transportation to doctors’ visits, regular physician follow-up and obtaining medical records. These value-added services reap big rewards when it comes to shortening A/R days.
bethany

Bethany Bailey
Vice President and Eligibility Expert

Is your outreach missing essential groups?

Uncategorized

8739414_orig

As time approaches another Open Enrollment for the Healthcare Exchange, hospitals are reminded of the many people still uninsured who, even though they are eligible, are not utilizing the Healthcare Exchange.

Who is still uninsured?
Statistics show that 15 million men are uninsured in this country, half of which were non-elderly adults. Nearly a third of those uninsured reported having trouble paying medical bills and 4 out of 10 uninsured men are now eligible to receive coverage through the ACA Healthcare Exchange. So why is this group not participating in the Healthcare Exchange? Researchers have polled this population and have found them to be skeptical about engaging with government programs due to lack of information about availability, the perceived difficulty of the application process and exclusion to Medicaid prior to the ACA expansion in some states.

Another significant demographic that is not participating in the Healthcare Exchange are those aging off other insurance options such as Medicaid or their parent’s insurance plans. According to reports, only half of these young adults leaving their parent’s plan are buying insurance for themselves through the Exchange. This is likely due to the high insurance premiums offered by the plans.

As a hospital, what can you do to successfully reach those people and increase participation?
You and your local CAC’s or Navigator Organization can begin outreach efforts in community locations such as college campuses, churches, barber shops, extension centers and libraries. In addition, organizations can also reach out to small business organizations and job placement centers to have information available to the people they assist. In a concerted effort to reach the younger population, hospitals can join in the outreach that has begun via email and partnerships with companies that are widely used by the younger population such as Lyft and Uber.

Why is targeting these groups critical to you as a healthcare organization?
Because 68% of the eligible people in these groups have very few health risks, their participation in the healthcare exchange by obtaining insurance decreases the risk pool, thus decreasing the cost of healthcare.

Kary Wallace, Director of Training and Compliance

High deductibles increasing self-pay amounts

Uncategorized

The topic of rising deductibles that have come along with the implementation of the ACA is hard to avoid these days. In a report put out by the Kaiser Family Foundation, the average deductible is more than triple what it was a decade ago, which is seven times faster growth than wages have risen in this same period. With such a rapid increase in deductibles, many patients are left a steep and unrealistic amount of hospital fees that they simply cannot pay. We have advised and consulted on this matter quite a bit recently and have determined that this influx of unpaid deductibles going to bad debt or charity is an increased pain point for hospitals and should be addressed similarly to other self-pay accounts.

The good news is that there are recovery solutions that hospital facilities probably already have in place that will certainly help recover some of those at-risk dollars. More than likely, those patients with high out-of-pocket expenses are first time insurance holders who may be in need of more information regarding the aspects of their plan and what is and is not their responsibility to pay. We recommend simply expanding the scope of which your financial counselors are working these accounts. Beyond payment plans, discounts and charity applications, Financial Counselors can be providing much needed education to your patients to help them better understand their bills, the breakdown of financial responsibility and the insurance process. If you have a vendor onsite that provides certified application assistance or ACA Navigator services, ask them to assist with providing educational materials or community outreach activities that assist with relaying this information to your community as well. In addition, you and your financial counselors can begin “front loading” your collections efforts for patients with pre-scheduled services. By arranging payments ahead of the service time, you can offer these patients “prepay” discount’s to ensure you are getting a portion of the patient’s responsibility upfront. “Front loading” can also work in situations where patients have limited plan coverage and need additional program assistance screening from your eligibility vendor.

Certified Application Counselors for the 8739414_orig

STANDARD REPORTS ARE A THING OF THE PAST

Uncategorized

Ideally, your vendors provide you and your team with reports that are an integral tool to measure key performance indicators, assist with monitoring current processes and guide your monthly budgets and projections. Depending on your role in the Revenue Cycle (Business Office, Patient Access, CFO,) customized and easy to understand data is necessary, but often difficult to obtain from your vendors.

• Have you asked your vendors to make changes to reports and never see the changes made?

• Is the data confusing or hard to read?

• Are the reports relevant and accurate?

One of the biggest frustrations we hear about from hospital management across the country is the way data is presented to them. We have seen other vendor reports inflate pending dollars and give deceptive conversion rates. The most effective solutions are timely customized reporting, user-friendly dashboards, real-time reporting and ad hoc requests with a 24-hour turnaround. Standard reports are quickly becoming outdated and vendors should be advancing their technologies to seamlessly provide each end user with only the information they request.

Safety-Net Medicaid Eligibility

Medicaid Eligibility, Third Party Eligibility, , , , ,

canstockphoto4059461

By now, secondary eligibility has made a name for its self in the Hospital Revenue Cycle, but depending on your experience with this service there may be some mixed feelings about it. Typically, secondary Medicaid eligibility is used as a safety net behind primary vendors or in-house teams to maximize revenue recovery opportunities that may have been overlooked the first time. Some hospitals may choose a safety net vendor if they feel that their primary is under-performing or may opt out of this service if they feel that the eligibility team is surpassing conversion expectations. If your primary vendor is a lot to manage already, the thought of adding another vendor may seem cumbersome or you may fear it will cause interruption. The truth is that these assumptions are inaccurate for the most part, and there are several other factors to consider when determining if your hospital would benefit from a safety net service.

Safety net services are done completely behind the scene, are noninvasive to current processes and a contingency-based pricing schedule makes the recovery service risk-free. Because secondary cases are usually more difficult or are approaching deadlines, successful secondary vendors work referrals as thoroughly and rigorously as they would if they were the primary.

Do you feel like your Medicaid conversions should be higher? Has your third-party vendor become complacent on high or low dollar accounts? Are monthly reports leaving you uncertain about the data being received? A secondary vendor can ease those pains points by providing a closer look and offering expert advice.

If your hospital facility has more than 150 beds or a self-pay population of more than 10%, we strongly recommend a secondary eligibility vendor, regardless of the primary vendor’s performance. We have seen first-hand that adding some friendly competition to run eligibility behind the existing process can dramatically increase performance from all parties.bethany

Bethany Bailey
Vice President and Eligibility Expert

3 YEARS INTO THE HEALTHCARE MARKETPLACE

Uncategorized

Over the past three years, RCA has embraced changes that the Affordable Care Act has given us and instead of viewing them as challenges, we have found an opportunity to be at the forefront of it.

As a Certified Application Counselor Organization, we provide education and assistance to our hospital client patients and general public enrolling in the healthcare exchange. Our clients turn to us with questions and concerns that we can confidently address for them.

So, are people signing up?

The answer really depends on whether or not your state expanded Medicaid.

In non-expansion states, there is still a gap of uninsured people that do not qualify for Medicaid and insurance premiums are too high for most to afford. Since the government knows this, they have waived the penalty fee for those taxpayers in non-expansion states who do not qualify for Medicaid. The result of this has been less enrollments and the self-pay population remaining largely unchanged.

If you are in an expansion state, chances are you have seen a decline in the self-pay population. With that decrease, healthcare professionals are going to see more Medicaid; however, the reimbursements in some cases have been reduced. For hospitals, finding revenue in remaining at-risk populations, such as non-citizens, has never been more important than it is at this point in time.

8739414_orig

Follow-up is key to effective Medicaid reimbursements

Medicaid Eligibility, Third Party Eligibility, , , , ,

hourglass

For best results and timely reimbursements, follow-up needs to be rigorous and consistent. RCA has heard from multiple clients that their eligibility vendors failed to stay on top of accounts and the money eventually ran away from them. Noncompliance and difficult patients are pain points that are made easier through constant contact and account monitoring.

From the minute your uninsured patient leaves the hospital, the clock begins ticking and that revenue becomes harder to recover. In many cases, patients are hard to reach by phone, do not respond to mail correspondence and even the most thoroughly trained staff will struggle with gathering the much needed documentation for maximum reimbursement.

We’ve found that weekly communication to the case worker, agencies and the patient is critical to shortening the amount of A/R days to payment. In search of discharged patients, sometimes this consists of measures including home, jail and shelter visits, transportation to and from appointments, translations services and skip traces.bethany

Bethany Bailey

Vice President of Operations

Losing self-pay dollars?

Medicaid Eligibility, Third Party Eligibility, , , , ,

Losing self-pay dollars is not a fight you should walk away from. Whether your facility manages eligibility in-house or has partnered with a vendor, there are still parts that need monitoring to make sure you and your patients come out the winners.

We have been asked to perform hundreds of eligibility audits to determine if money is being left on the table; below are the biggest pain points we evaluate during a standard review.

canstockwebPromptness of Inpatient screening – It is easy to assume the patient is being screened for government assistance before they leave the facility, but unfortunately that is not always the case. This is the first place our experts evaluate. To make a quick determination and build a relationship with the patient, your eligibility team needs to be doing screenings within 24 hours of admission.

Follow-up on account progression – It is very important to monitor self-pay accounts regularly. If we don’t see regular notes made in the hospital system regarding account progression, it’s a red flag that the current process may be hurting the bottom line.

Payment follow-up – Your eligibility vendor or in-house team needs to make payment follow-up a priority in the recovery process. We find billing and payment to be an easily missed task and a costly point in the revenue cycle. A successful eligibility process does not end with follow-up. The most important piece is ensuring the hospital receives payment.

Depending on the patient mix, self-pay numbers can range making it hard to determine exactly how much a hospital’s recovery should be. Typically, we’ve seen anywhere from 20-30% of self-pay populations qualify for assistance in non-expansion states and conversions rates on net placements between 91-96%. We suggest you take a closer look at the above-mentioned points of your eligibility process if your numbers seem lower than our expert advice.

bethany

Bethany Bailey
Vice President and Eligibility Expert