Wednesday, May 27, 2015

Pre-Screening Patients for Medicaid Eligibility

Growing financial pressures are forcing hospitals to re-evaluate the question of what makes good revenue cycle management. Processing claims and payments isn’t enough. Hospital administrators need to be able to maximize their ability to capture revenue from all of their patients – regardless of their current financial situation.

One way that hospitals can do this is by pre-screening their patients for Medicare eligibility at the time of admittance. Many hospitals do not do this until a patient has already been discharged, which increases the potential for an unpaid bill. They may also rely on their own organization’s charity care programs rather than exhausting the ability of a patient to cover their costs through Medicare.

Verifying a patient’s eligibility for coverage under Medicaid is also problematic. It’s not uncommon for a patient denial to occur because of front end issues with the pre-screening process. A lack of education or unfamiliarity with requirements can mean that denials of coverage are given because the wrong demographic or coverage information was entered or because enhanced requirements for authorizations of service for Medicaid patients were not met.

Organizations can improve their revenue cycle management by placing an emphasis on performing effective pre-screening for hospital patients, particularly those whose services could potentially be covered by Medicaid or other forms of government coverage. Shifting from a reliance on self-pay or organizational charity care programs and taking advantage of potential coverage through Medicaid can reduce lost payments and time spent handling eligibility issues.

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