Medicaid eligibility is complicated by regulations that tend to change from year to year (and from one presidential administration to the next) and vary widely from state to state and, in some cases, by locality. Expansions. Extensions. Exemptions. Waivers. Experimental programs. That’s a lot of information to digest, and during extraordinary times such as a pandemic, this information can change almost overnight.
Staying up to date on Medicaid and other healthcare coverage options, and the changing rules and regulations surrounding them, is a full-time job that requires ongoing attention and effort. Your organization’s ability to stay on top of the available reimbursements, and comply with federal, state and local regulations in seeking these reimbursements, could make a significant difference in its bottom line.
The familiar mantra “think globally, act locally” could well be applied to Medicaid eligibility. While eligibility advocates are invested in the well-being of the individual patient, provider and community, the most successful ones also have the ability to discover and leverage best practices from across the spectrum.
Such an eligibility department provides invaluable benefits to a provider, including:
Providers cannot afford to overlook potential sources of reimbursement, whether inside or outside of the Medicaid arena. Effective eligibility advocates recognize the need to sometimes seek alternative paths to account resolution. They also know the necessity of compliance and the penalties for failing to comply. Their expertise is crucial to letting providers focus on what they do best—caring for patients—instead of being distracted by cash flow or regulatory issues.
Parallon’s scale, experience and relationships across state lines have forged a global perspective that benefits the providers we serve. We constantly look for opportunities to broaden our wisdom and share it, when applicable, with other providers and among states.
Our experience working with providers in Virginia during that state’s Medicaid expansion is just one example of how this cooperation pays off. After Virginia’s expansion brought providers a boost of both revenue and patient eligibility, we used those lessons to generate staffing proposals during Medicaid expansion efforts in Missouri. Although the Missouri legislature ultimately rejected the expansion, voters approved it, and the experience will be useful as other states consider their own expansion options.
“We’re all in this together,” one Parallon leader explained. “We’re all here to do the same thing, and that is to help people who need help.”
Whatever state you’re in, you need a Medicaid eligibility team that understands not only your unique situation but also how it fits into the larger landscape and how it can benefit from others’ hard-earned wisdom.