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 Challenges of Processing for Medicaid Claim

Medicaid comes into general types - Community Medicaid, typically given to qualified individuals who have little to no coverage; and Medicaid nursing home coverage, which shoulders the costs associated with staying in a nursing home.

One of the challenges that come with a Medicaid claim is the fact that coverage qualification and policy details can vary from one state to another as well as from one provider to the next. In here alone, a lot of money is lost if the encoding is incorrect. By getting a proper software application, or by having an experienced service provider, the process of checking for eligibility for Medicaid can be simplified without necessarily compromising accuracy.

Taking Into Consideration Medicare Coverage

Some patients would have both Medicaid and Medicare coverage. If that is the case, the information typically gets processed through Medicare without much problem; however, you need to make sure that you have all the details encoded correctly. Keep in mind that Medicaid makes use of a schedule of fees, unlike Medicare. If you encoded the incorrect procedure, you might have your patient paying more than he or she should.

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