When it comes to your Medicaid third-party liability program, be weary of contractors and vendors selling style without substance.
Third-party liability (TPL) is essential to the integrity of the Medicaid program and its ability to serve our nation’s most vulnerable. Billing liable third parties the first time around means fewer dollars lost in improper payments, less administrative hassle to get them back and a stronger safety net for those who rely on it most.
As state Medicaid agencies, managed care organizations (MCOs) and, certainly, their TPL partners can attest, coordinating benefits for the approximately 10% of Medicaid members who have other sources of insurance coverage is far more complex in practice than in concept. Procedural denials, data sharing limitations and administrative constraints are just a few widely cited barriers to capturing TPL and protecting Medicaid as the payer of last resort.
The stakes for getting payments right are higher than ever. In 2020, the Centers for Medicare and Medicaid Services reported an estimated $86.49 billion in improper Medicaid payments — a sobering figure considering millions more Americans are turning to Medicaid during the current health and economic crisis.
Fortunately, there are healthcare experts and analytics-driven solutions that manage TPL on behalf of Medicaid programs and streamline the process for states and healthcare organizations. Unfortunately, there are also diverse, industry-agnostic firms that may lack specialized knowledge and tools but make up for it with gratuitous claims and analytical jargon. Which one are you getting and why does it matter? Here’s what to look for — and look out for — in a TPL contractor.