Out of State Medicaid Management E-mail

The ChallengeImage

The overall challenges of insurance claim submissions and collection has become the weakness facing many of the hospital’s Patient Financial Service’s Departments. Management teams are not only dealing with monetary cutbacks due to a cost base reimbursement from the insurance carriers; they are also, faced with being recognized as an eligible participant within the patient’s insurance network. Out of State Medicaid plans are no exception to these guidelines and conditions. The problem most hospitals are having is the capability of maintaining a receivable at acceptable levels. The process requires an increase amount of follow up and consideration, equal to their highest payer; and then at the end of the day receiving a further lesser payment, in their return on investment.

Our Approach to the Solution

PF Concepts believes this should not be a forgotten receivable, and recognizes it should have the same focus and intensity as all of the other account receivables. Our Out of State Medicaid program has helped to collect this receivable and establish open communications with the various Medicaid fiscal, agents to expedite payments to the providers. We are committed to these provisions and required follow up to theses Out of State Medicaid plans. PF Concepts works very closely with the various fiscal agents to finalize all claims. Our efforts are based on the necessary time devotion and aggressive procedures that produces results, with a payment.

Typical improvements include:

  • Decreases in the aged receivable
  • Increases in follow up and follow through with the Out of State Medicaid accounts
  • Re-direction of the Hospital’s Patient Financial Services’ staff focus to other problematic payers
  • Increases in cash collections
  • Improvements in the knowledge and monitoring of the out of State Medicaid claim processing procedures
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