Are Medicaid eligibility requirements negatively impacting your bottom line?

With limited income and resources, a significant portion of today’s population depends on Medicaid for assistance with mounting healthcare costs. At the same time, Medicaid’s complexity leaves many qualified patients confused as to how to achieve and maintain coverage.

For starters, Medicaid eligibility requirements can vary considerably based on one’s state of residence, age group, desired program, and other factors. In fact, given these variables, there are literally hundreds of different sets of eligibility rules for long-term Medicaid coverage throughout the US. What’s more, eligibility hinges on one’s documented financial income and an approved medical need for care.

To further complicate matters, Medicaid coverage can lapse from month to month due to an address change or even a slight or temporary income adjustment. Proactive analysis and scrutiny of potential fluxes in eligibility are critical for those receiving long-term healthcare services. Under the current structure, patients in settings such as intermediate care facilities, nursing homes, or behavioral health treatment centers run the risk of losing coverage at a moment’s notice which can negatively impact patient satisfaction and your hospital or healthcare organizations bottom line.

Establishing effective recurring enrollment processes is key to ensuring that patients can sustain their benefits for the long term. By emphasizing recurring enrollment deadlines, assisting with renewal applications, and offering support for those who unexpectedly become ineligible, patient-focused programs can have a vital impact on not only improving community health, but also strengthening your hospital or healthcare organizations revenue cycle and bottom line.

In many cases, the most successful eligibility and enrollment programs are founded on strong relationships with state and federal agencies who administer the regulations that dictate accessibility. Building sound partnerships with these organizations will facilitate ongoing Medicaid and/or Medicaid Waiver enrollment for clients. Therefore, a thorough and extensive operation should handle much more than the completion of applications on behalf of clients.

With over 30 years of revenue cycle expertise, Savista’s eligibility and enrollment experts can help your healthcare organization navigate unusual or complicated circumstances to alleviate the burdens placed on patients struggling to renew coverage. If coverage is lost, for instance, a client may need expert assistance to secure retroactive enrollment for uncovered dates of service. In the same vein, a well-connected program can help manage Medicaid rejections to overturn denials and facilitate re-billing or appeal unfavorable outcomes regarding Medicaid and Social Security.

Read our latest whitepaper to learn more about the critical changes in healthcare eligibility and enrollment.

With over 30 years' experience, Savista provides flexible and consultative revenue cycle management services to acute and ambulatory facilities and systems. We enable our clients to navigate the biggest challenges in healthcare with optimal financial results. For more information, please visit www.SavistaRCM.com.