Medicaid Enrollment and Discovery E-mail

The ChallengeImage

In order to receive timely and accurate payments from Medicaid a hospital must identify the eligible patient population, the appropriate program source, and must be in strict compliance will all of the Medicaid requirements. The Medicaid program reimburses based on patient, service and date eligibility, which can be difficult for a hospital facility that does not adequately trained staff or familiar with the process requirements that the program eligibility needs.

Our Approach to the Solution

The payment of services provided to eligible Medicaid recipients equates to an accounts receivable resolution, provided there is a timely and accurate submission of the claim. PF Concepts provides their expertise in this area of qualifying eligible patients for the various Medicaid programs that are available. We provide our year of experience and knowledge of the program eligibility and process requirements. This assistance alleviates the difficulties that have been experience by facilities. An added value, the PF Concept’s team has the knowledge and the systematic ability to discover Medicaid eligible patients that have been classified into other financial classes. These accounts are mined out of the general population of the receivable and are identified with an eligible recipient identification number, which has eligibility for the respective dates of service. This service has the flexibility to be designed to the exact needs of the client from the point of service entrance or the simply and natural need to accommodate the patient.

Step 1: Assisting the patient in all ways necessary, co-navigation through the processes
Step 2: Assessing and assisting with the full needs of the patient               
Step 3: Consistent and continuous follow up with the appropriate County Agency, proceeding based upon the requirements for a favorable decision of the application process
PF concepts take an “Ownership” approach to the services that we provide, by not only engaging the appropriate Medicaid program for the immediate needs, but the on-going needs of the patient, as well.

Typical improvements include:

  • Increases in Medicaid reimbursement
  • Increases in “DSH” fund eligibility
  • Reduced Accounts Receivable
  • Decreases in Bad Debt and Bad Debt Expenses
  • Increases in Community and Patient satisfaction
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