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Martin Memorial Health Systems in Stuart, FL, reports an increase in authorization requirements for inpatient and outpatient accounts.
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After patient access staff at UNC Health Care in Chapel Hill, NC, began receiving bi-weekly reports on how much they collected, their performance began to improve.
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When a new emergency department (ED) bedside co-pay collection process was implemented at Middlesex Hospital in Middletown, CT, access reps were "very, very nervous about what the reaction was going to be," recalls Margaret Trudel, patient access manager.
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Claims denials often occurred because the patient's disposition didn't match up with what the Centers for Medicare & Medicaid Services (CMS) required to authorize a procedure, reports Maura Corvino, MSOL, RN, CEN, assistant vice president for emergency services and patient access at Valley Health System in Ridgewood, NJ.
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If a patient gives untruthful information to registrars to avoid paying for services, this fraud can result in dangerous clinical outcomes as well as lost revenue.
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When you consider the newly eligible population coming onto your state's Medicaid program in 2014, remember that "those 32 million people out there are already being seen somewhere. They are being seen by a range of safety net providers," says Georges C. Benjamin, MD, FACP, FNAPA, FACEP(E), executive director of the American Public Health Association in Washington, DC.
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Ensuring access to primary care in Medicaid is going to take a "multi-pronged strategy," according to Julia Paradise, MSPH, an associate director of the Kaiser Family Foundation's Kaiser Commission on Medicaid and the Uninsured and lead author of the organization's March 2011 brief, Improving Access to Adult Primary Care in Medicaid.
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"Increased support for primary care providers who participate in Medicaid is one lever for securing more capacity in the program."
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There isn't a lot of data on the cost savings of state medical home initiatives because the state pilots and demonstrations are still new, according to Mary Takach, MPH, RN, the lead researcher on the Washington, DC-based National Academy for State Health Policy's Medical Homes II Consortium project.
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The impact of Medicaid on state budgets is often overstated, according to a March 2011 report from the Georgetown University Health Policy Institute's Center for Children and Families in Washington, DC.
