Eligibility Partnership Case Study
Health System Partners with RCM Vendor to Streamline Medicaid Program and Significantly Increase Reimbursements
The Challenge
In early 2020, a large non-profit health system on the East Coast decided that its Pending Medicaid program could be more effective. The program was fragmented, with siloed responsibility. Many areas of the process needed additional oversight, and internal staff needed help with delays and confusion that resulted in denials, and lost revenue with self-pay accounts, Medicaid, and other potential reimbursements. The health system realized that as its uninsured patient population grew, it was necessary to augment, streamline, and standardize their processes by partnering with a trusted revenue cycle vendor that could increase conversions and reimbursement, and while providing compassionate financial advocacy for their patients. Upon close examination, the system estimated these process issues led to a loss of $13 million in potential revenue.
The Solution
The system partnered with Elevate Patient Financial Solutions℠, working side-by-side to overhaul their Pending Medicaid process. The ElevatePFS team focused on connecting and collaborating with stakeholders across the hospital system and established a trusting relationship with their leadership. ElevatePFS worked alongside the Pending Medicaid team to streamline the process by facilitating accountability, expanding the program’s impact, and identifying the barriers to efficacy and success. For example, one easy-to-address change was using ElevatePFS to leverage online applications and electronic submissions for faster claim approval, rather than relying on traditional methods of mail or fax.
With the help of the ElevatePFS team, the health system was able to centralize medical record requests and emergency medical certification collections underneath the Pending Medicaid process. This shift reduced response times from 30 days to less than 48 hours. Instead of mailing certifications—which delayed the process, sometimes more than a year—the team switched to an electronic system, cutting the number of accounts older than one year by 85%. Aggressive management of the work queue reduced the number of claims from 9,500 to 2,500.
The Results
In partnership with ElevatePFS, the health system built a single process that brought multiple account management systems together, creating a more efficient operation. From 2019 to 2020, processing times improved by 15 days, and Medicaid reimbursements increased by 27%. This allowed the system to reach more patients and significantly increase access to care. The overall increase in performance during this timeframe was more than 50%, with over 80% improvement in the emergency department.
Not only was the ElevatePFS team able to help the health system successfully navigate its obstacles, but they also helped the home state’s Medicaid department identify program issues resulting from the pandemic, resolving a backlog of more than $15 million in charges. In addition, ElevatePFS escalated an issue with the border state’s Medicaid department to the state’s Secretary of Health to resolve more than $4 million in backlog charges.
The Elevated Difference
Elevate Patient Financial Solutions℠ combines comprehensive eligibility screening, efficient and streamlined processes, and compassionate advocacy to enroll patients in available coverage programs to help pay for care. The ElevatePFS solution meets patients’ needs and positively impacts a client’s bottom line. In-house eligibility screening starts at the patient’s bedside with compassionate advocates who are committed to identifying and securing any potential programs. ElevatePFS advocates focus on exceptionalism and compassion to ensure the patient comes first in every encounter, and clients see results with a reporting system that spots key trends, giving them the insights needed to continually improve their processes.