Friday, December 11, 2015

Eligibility Management for SSID Candidates

These candidates are possible clients for your hospital or health care institution, this is why having an eligibility management service tasked to lessen the process of claiming revenue from the eligible candidate and the health insurance providers that they have applied under. Having a system that manages these claims and supplements the existing revenue cycle management system of a hospital or healthcare provider makes claiming smoother and increases the revenue wholly in a short period of time.

Outsourcing Help for Revenue Cycle Management Operations

Outsourcing has become one of the biggest ways that a company goes on with its operation. It is no different from hospitals and healthcare providers. They employ outsourced services for some of their tasks such as some of the administrative work that they process. Outsourcing a part or a whole operation solely depends on the company, but outsourced services are flexible in providing, no matter what the services are required of them.

Monday, December 7, 2015

Eligibility for Medicaid: How Improving Your RCM Can Help

Medicaid is a state-administered program that covers the medical expenses of individuals with low income. With the passage of the Obamacare Act, the minimum eligibility for Medicaid has been set at 133% of the federal poverty level. While most individuals would rejoice at the approval of this Act, it can prove to be quite challenging for healthcare providers.

The Need to Ensure Patient Eligibility

One problem that weakens a hospital’s revenue cycle management is the failure to ensure patient eligibility for insurance. Because many practices don’t have the time to gather insurance information when a patient calls to set up an appointment, the risk of claims being denied is higher. In fact, thousands of claims are denied due to eligibility issues, thereby affecting the hospital’s revenue. This is why it’s important for hospitals to find a partner who can do this task for them.

Monday, November 23, 2015

Affordable Care Act Marketplace: Qualifying for Premium Tax Credits

The sum of your modified adjusted gross income to that of every family member for whom you can claim a personal exemption deduction, and is also required to file federal income tax return, is your premium tax credit. Modified adjusted gross income (MAGI) is your adjusted gross income plus excluded items like foreign income, student-loan deductions, nontaxable Social Security benefits (excluding SSI), etc. accrued or received during the taxable year.Each level of the FPL is entitled to a different tax credit amount. You may consult with marketplace navigators from companies like DECO to determine the amount of premium tax credits, along with new health insurance marketplace coverage options you may be eligible for.

Sunday, November 22, 2015

Helping an Abused Child? Disability Social Security as Restitution

Every child is entitled to be raised in a loving and caring environment. Sadly, for some 750,000 children in the U.S. who are victims of abuse, the picture of a healthy childhood, without due intervention and restitution, is beyond reach. Child abuse chooses no status, religion or culture, and it’s inflicted in varying degrees. From calling the child derogatory names, threats of abandonment, neglecting medical care, to physical battery and sexual assault, child abuse can leave severe and long-term damage to a child to the point of disability.

Saturday, November 21, 2015

Determination of Eligibility for Medicaid Is Complex Yet Important

Medicaid is among the healthcare coverage options provided by the U.S. government. The coverage can help both patients and hospitals.Healthcare.govindicates that Medicaid provides low-cost or free healthcare for low-income people and families, which is applicable to all states.How Eligibility Can Become ComplexThe definition might seem simple enough but the complexity lies in what is considered “low-income”. It is quite subjective since anyone who experiences difficulties in everyday expenses may feel that his/her income is low. In the case of Medicaid, the regulating entities use a definitive basis, which is the Federal Poverty Level (FPL) – a value calculated and updated every year by the Census Bureau.

Friday, November 20, 2015

Uncompensated Care and How Revenue Cycle Management Services Help

What is revenue cycle management assistance good for in medical practice? The main function of this is to maximize revenue by reducing cases of uncompensated care – a combination of charity care and potential bad debt. Accumulating uncompensated care is a huge concern across the healthcare industry. This cripples the ability of hospitals to manage expenses as it takes away profits that would have otherwise been used for hospital needs, such as equipment, medications, and other supplies. As a result, they have a hard time providing efficient care, creating a ripple effect from the immediate community to the nation as a whole.

Monday, November 9, 2015

Understanding the Revenue Cycle from A Billing Perspective

In the past, the idea of revenue cycle can raise eyebrows and strange looks from doctors and hospitals administrators. After all, why would there be a need for a management system when there is already the billing section and the revenue section? Today, however, it’s a different story what with RCM being a tool that allows company to ensure timely payment and increased revenue from patients and third-parties.

How Your RCM can Help Ease Life for the Disabled

Living with disability is living a life full of obstacles. A disability, in the broadest sense, is a condition that impairs the ability of an individual. People living with disabilities are susceptible to experiencing more hardships, in the form of physical, mental, or social barriers, sometimes all at once.

Wednesday, November 4, 2015

Understanding the Importance of Revenue Cycle Management

Simply put, Revenue Cycle Management allows hospitals and other medical establishments to ensure the timely collection of payment from individuals and insurance providers. In order for this to happen, RCM makes use of a number of tools in the form of software applications in order to retrieve and analyze data as well as check for eligibility for medicaid and other coverages.

Understanding the Basics of RCM

While most people see Revenue Cycle Management as simply the billing and filing the claims of patient, that is not actually the whole picture. True, the whole revenue cycle management starts as soon as the patient steps inside a hospital or clinic.

Monday, October 26, 2015

House Bills Aimed at Intellectual Disabilities

Earlier this year, Florida took efforts into moving their state to the cutting edge in providing financial and educational opportunities for children having intellectual disabilities. This has been in the form of two separate bills, one of which aimed to provide tax-free savings accounts for disabled individuals. Another bill aimed to provide an opportunity for children with intellectual disabilities to take part in special education programs.

Monday, October 19, 2015

Speed Up Your Social Security Disability Claim

It is not uncommon for people to be held on a standstill while waiting for the Social Security Administration (SSA) to process their claims. The waiting time for a hearing with an Administrative Law Judge can take a year or even longer. Even worse, some people patiently wait the entire time only to find out that their claim has been denied. If you can’t possibly afford waiting for the average amount of time it takes for the SSA to process your claim, you there are a few things you can do.

Monday, October 12, 2015

What Healthcare Providers Should Know About Medicaid Eligibility?

Millions of Americans are eligible for Medicaid because of The Affordable Care Act. States are required to cover people that meet the Medicaid eligibility definition. Some states are refusing to expand their programs to poor Americans between the ages of 19 to 64. On the other hand, healthcare providers are welcoming the new law. This new law increases revenues for providers because millions of uninsured Americans are getting access to healthcare services.

Thursday, October 8, 2015

New Affordable Care Act Marketplace Options: Complexity and Efficiency

Healthcare financing processes in hospitals and other medical facilities are typically complex, resulting in a higher risk of errors that lead to revenue loss. In an ideal world, hospitals can provide care to people for free with no problems at all. In reality, however, hospitals need revenue so they can continue providing healthcare to the community. With that in mind, revenue losses can be very harmful, not only to hospitals but the communities they serve. Losses could slow down operations, and/or negatively affect the quality of care due to lack in crucial supplies or equipment, and similar effects. says that hospitals experiencing revenue loss may not close down altogether, but may have to adopt changes that could compromise the quality and accessibility of healthcare.

Tuesday, October 6, 2015

Some Special Situations for Social Security Disability Eligibility

Getting approved for social security disability eligibility is one of the hardest processes that some Americans have to face. Proving that you have a qualified disability alone already takes up a lot of time and effort on your part due to the numerous medical tests that you have to undergo, but the process doesn’t end with proving your disability. Afterwards, you still need to be assessed for your ability to work. For this, you need to prove to that your condition prevents you from doing any work at all, and that you have no means to support yourself due to your condition. There are, however, certain circumstances when the disability requirements for a disability social security approval will consider special cases

Monday, October 5, 2015

Collecting Revenue from Eligibility

Collecting revenue is essential for every active business. It is especially so for the medical profession, which works smoothly because of the use of expensive diagnostic equipment and highly educated staff that demand good salaries. It is not anticipated that indigent patients will ever pay their hospital bills, which only leaves a finance department that collects with efficiency all the monies due the hospital from all the available resources.

Sunday, October 4, 2015

Hospital Revenue Cycle Management—Time is Now for Value-Based Systems

The need to transition to a value-based payment system has turned the traditional healthcare reimbursement model on its head. In a recent Healthcare Finance article, KPMG—one of the largest professional services companies in the world—announced that 74 percent of healthcare providers are now in the beginning stages of investing in the method. Joe Kuehn, advisory partner at KPMG's healthcare & life sciences practice, mentioned this in a statement. ""It has never been more crucial for providers to prepare their finance departments to address the demands that new care delivery models, such as accountable care organizations and alternative payment arrangements, will present as the industry moves away from fee-for-service reimbursement mechanisms.

Friday, October 2, 2015

Revenue Cycle Management Services: Tips for Enhancing Profitability

It’s a given that providing quality healthcare is a medical practice administrator’s main concern. That being said, the practice’s profitability is equally important, for without it, the ability to provide quality medicine will be severely compromised. In 2012, Becker’s Hospital Review (BHR) posted an article detailing the 11 ways healthcare providers can enhance their profitability for the following year. Despite being practically three years old, most of the tips still resonate today, such as: Make a concerted effort to revamp the revenue cycle What is revenue cycle management to you? How much do you value it? According to the BHR article, one hospital CFO observed that some of the healthcare facilities he visited didn’t give it enough focus. Revenue cycle management poses one of the biggest opportunities for profit because it is completely within your facility’s control.

Monday, September 28, 2015

Different Kinds of SS Benefits for Children

Children can collect Social Security Disability (SSDI) or Supplemental Security Income (SSI) benefits in three ways. These may involve disabled children or children with disabled / retired parents.

Monday, September 14, 2015

Three Tips to Win SSD or SSDI Benefits

The process for receiving benefits from the U.S. Social Security Administration (SSA) is no walk in the park. You’d think people with disability will get special attention, but it just doesn’t work that way. In fact, according to the SSA itself, denied disability claims have averaged nearly 53 percent or more than half of all the applicants denied. You should not lose hope just yet, though. There are many ways you can improve your chances.

Monday, September 7, 2015

Eligibility for Medicaid: Benefiting Immigrants

According to an Examiner article published November, 2014, U.S. immigrants and their children account for 40% of Medicaid recipients, amounting to $4.6 billion.The figure is mainly attributed to the fact that a significant portion of admitted immigrants are in the low-income group, and could not afford insurance.

Thursday, September 3, 2015

Revenue Cycle Management: The Proactive Approach

Bad debts are one of the major reasons why healthcare facilities close. Although seemingly minimal when individually taken into account, when piled up, they can amount to significant revenue loss for a practice. In fact, in 2011 alone, the American Hospital Association estimated that healthcare facilities have lost $41.1 to uncompensated care, which also accounts for 5.9% of their total expenses. Some of this could have been preventable had these facilities started optimizing their revenue cycle management processes.

Friday, August 28, 2015

Huge Life Changes and New Health Insurance Marketplace Coverage Options

Making the right choices with regard to your health should be a top priority. If you’ve already selected one of the new health insurance marketplace coverage options available this year, yet wish to change it as a result of a significant life change, you’re not alone. You might not have to cancel your current plan altogether but just tweak it. Your health insurance, after all, should adapt to your needs.

How Claim Conflicts Affect RCM

A vital part of a hospital’s revenue cycle management (RCM) is managing claims. In many cases, patients simply can’t, or at least not fully, pay hospitals out-of-pocket. Instead, their payment will come in the form of an insurance or government benefits program. The insurance provider or the government will hand the payments to the hospital but not before a claim is made and approved.

Thursday, August 27, 2015

Reasons for Denial of Claims for Mental Disability Social Security

Winning benefits for a mental disorder is a particularly troublesome. The process of approval is already difficult enough as is, but claiming benefits for mental illnesses is harder still and often leads to getting denied. If you or your loved one is applying for mental disability social security benefits, you should be aware of what likely factors could get your application rejected by the Social Security Administration (SSA). This way, you can prepare accordingly and limit your chances of getting denied. Late Diagnosis of Mental Conditions A mental disorder doesn’t always appear obvious. As a result, many individuals get diagnosed late. They struggle to keep jobs and would often have an odd work history. Since benefits can only be received by people who have paid into the system through paycheck deductions, this is often a problem. Many even qualify for very little amounts under Social Security Disability compared to those with obvious physical impairments.

Wednesday, August 26, 2015

Combating Claims Denial Now That Eligibility for Medicaid Has Expanded

Medicaid expansion under “Obamacare” is considered one of the biggest milestones in U.S. healthcare. It reaches out to the country’s poorest, covering almost half of all uninsured Americans. More people in states that have expanded Medicaid can now benefit from free or low-cost healthcare provided they meet certain income requirements, regardless of their family status, disability, and a lot of other factors that are typically considered in evaluating eligibility for Medicaid. In the medical community, Medicaid expansion has garnered different reactions. The government agency is notorious for taking a long time to pay claims and for denying claims frequently. Additionally, some doctors even claim to be paid less than the actual cost of their services. It’s no surprise, therefore, that with all these reimbursement concerns, many physicians have avoided taking Medicaid patients even before the passage of the act.

Tuesday, August 25, 2015

Revenue Cycle Management Companies Can Make Healthcare More Efficient

To keep your healthcare facility running, quality service must be backed up with profitability. To ensure that adequate revenues are getting into your cash flow, a revenue cycle management system must be set in place. Knowing what is revenue cycle management (RCM) is just the first step; the more important step is managing your facility’s income generation activities from claims processing and payment collection up to revenue generation. This cycle starts by the time a patient calls for an appointment and ends once the account balance turns zero. Process automation is not enough Disorganized and inefficient workflow, coding errors, lack of staff training—these are just some of the many factors that hinder optimal RCM productivity. Although there is software that let you effectively monitor the claim process, maintains that using them would be wasteful if you don’t eliminate fundamental problems prior to the implementation of said programs.

Monday, August 17, 2015

Why You Should Check Your SSI Claim Status

It’s easy to think that all you have to do is wait once you’ve accomplished all forms and handed them all to the SSA. The truth is you can’t relax just yet, not at least after you get approved. Many things can go wrong while your claim is being processed—errors can end up delaying your claim’s approval, which could put all your hard work to waste and send you right back to square one.

Wednesday, August 12, 2015

Senior Medicaid Eligibility and Long Term Care

Need financial assistance for nursing home or assisted living services? Medicaid can provide you with the needed finances through its Long Term Care program, designed for low-income seniors with limited assets other than the home they own. It can pay for almost all of your care needs, provided you are qualified.

Tuesday, August 4, 2015

What are RCM Best Practices for Denial Handling?

With more patients relying on the government to supplement their healthcare needs, every medical facility’s viability depends largely on effective revenue cycle management (RCM). One of the most important phases of RCM is denials resolution; a facility can lose thousands of dollars each year if they don’t appeal denials. This article will serve as a brief guide for billing officers:

Monday, July 13, 2015

SSDI for Adults Disabled Before Age 22

Disabled children under the age of 18 are the most common candidates to receive social security disability benefits (SSDI) for children. Adults disabled before age 22, however, can also be eligible for these benefits if they have a deceased parent, or if their parent starts receiving retirement or disability benefits. This is considered under the SSDI for children because it will be paid on the parent’s Social Security earnings record. Therefore, even if the child has never worked, he/she will still be qualified to receive benefits. 

The Social Security Administration (SSA) calls these beneficiaries “adult children”. An adult child doesn’t necessarily have to be a biological child of the parent. He could be an adopted child and in some cases, a stepchild, grandchild or step grandchild. The adult child must be aged 18 or older and unmarried. If the adult child marries, the benefits are going to end. However, some marriages can be considered protected. For instance, if an adult child marries another adult disabled child, he will continue to receive benefits.

The SSA will only consider disability that started before the age of 22. The agency takes a closer look at an adult child’s disability under the same rules used for evaluation of adult disability. 

These are the things that medical practitioners and facilities, and their patients, may not be familiar with. The assistance of eligibility experts is needed in determining healthcare eligibility for adult child patients, so these patients could settle bills through SSDI.

Application Mistakes That Delay SSD Judgment

Generally, delays in social security disability (SSD) judgments are due to the number of disability appeals being filed, which is much more than what a small circle of administrative law judges can manage. Unfortunately, many applicants think that the process is a mere filing of forms. As such, they often make mistakes that contribute to further delays.

Inaccurate Medical Information

Disability claims are forwarded to the state disability agency to verify medical records and screen them for the SSA. This agency gathers all medical files from the medical sources an applicant indicates in his form. The wait usually lasts for months, and delays can be lengthened when the medical information gathered are not up-to-date (within the past 90 days) or the records do not completely match the condition claimed. In this case, the applicant may have to undergo a consultative medical exam under SSA’s charge.

Lack of Understanding About Qualifications

The SSD process can be complicated and not everyone functionally impaired may fit its description of “disabled”. An applicant must satisfy a certain set of conditions to qualify for the insurance. For instance, a 30-year-old electronic quality auditor who hurt his back in a workplace accident may not be considered disabled by SSD if the injury does not really prevent him from doing his job, unless he can present compelling evidence to the contrary.
Eligibility services help SSD applicants improve information accuracy and understanding, to hasten judgments for the applicant and reimbursements for the medical facility.

Get Your Children Enrolled in Medicaid and CHIP

Lack of healthcare coverage often means that primary care is an out-of-reach luxury. Yet primary care plays an important role in an individual’s health, as it helps prevent or treat illnesses before they turn serious. For parents in low-income families, Medicaid and Children’s Health Insurance Program (CHIP) are  viable ways to provide their children with comprehensive and affordable health coverage, especially when they can’t afford coverage on their own or do not receive health benefits from their jobs. 

Whether you’re just starting or are looking to improve your child’s existing coverage, here are some tips for Medicaid and CHIP enrollment that you can use:

Learn Your State’s Specifics

Familiarize yourself with your state’s particular enrollment steps. Every state provides health coverage for most low-income children, however, enrollment procedures, eligibility requirements, and cost-sharing rules will vary across the country.

Consult groups with Direct Medicaid and CHIP Knowledge

Get in touch with groups with whom you regularly work with and reach out to other groups as well. This includes community organizations, clinics, ministers, school personnel, elected officials etc.—anyone who has contact or influence in the lives of families and who will have an interest in enrolling children in health coverage.
You can apply for these programs any time of the year, and if you qualify, your coverage can begin immediately.