Medicaid Eligibility
As part of the end-to-end continuum of services that RPM offers to its hospital and medical provider clients, we are very proud to include with our other services a Medicaid Eligibility Program that fills the gap that often exists in reimbursement today. This program provides many benefits including fulfilling the following goals:
Maximize Reimbursement from Medicaid Sources
RPM will provide staff on-site on a regular schedule to review every self-pay admission to identify patients that are potentially eligible for Medical Assistance. We will interview patients, family members, doctors, nursing staff and social workers to determine potential eligibility. If the patient appears to be potentially eligible, an application for Medical Assistance is completed at that point. While we are with the patient or family members we obtain all necessary signatures and information to allow us to go forward with the application process on behalf of the patient even if we have no further contact with that patient. We ask that the patient sign a form authorizing us to represent them in the process. We also ask that the patient sign consent to release information forms so that we can go about the business of gathering eligibility documents needed in the process. We find that this is the best way to be sure that all patients that are potentially eligible have an application completed.
We are very proud to include with our other services a Medicaid Eligibility Program that helps maximize revenue and limits bad debt. To the extent our client is eligible in their geographic location for other state, county or other local medical assistance reimbursement, RPM will pursue these alternative sources or reimbursement. Alternatively, if an account is eligible for reimbursement from a fund set up for a specific purpose, i.e. victims of crime, patients under the custody of a police organization, rape victims, these sources of reimbursement will also be pursued in a manner similar to our Medicaid Medical Assistance Application Service.
Medical Assistance Application Services
Often times this is a patient population that is unwilling or unable to get through the eligibility process on their own. It is our goal to recognize that fact and complete the process on behalf of the patient. These are the patients whose accounts without intervention will ultimately be determined self pay bad debt.
RPM provides staff on-site on a regular schedule to review every self-pay admission to identify patients that are potentially eligible for Medical Assistance. We interview patients, family members, doctors, nursing staff and social workers to determine potential eligibility. If the patient appears to be potentially eligible, an application for Medical Assistance is completed at that point. While we are with the patient or family members we obtain all necessary signatures and information to allow us to complete the application process on behalf of the patient even absent further patient contact. We ask that the patient sign a form authorizing us to represent them in the process and obtain a signed consent to release information form allowing RPM to gather the needed eligibility documents.
In addition to staff on site at the hospital, RPM provides field service staff to do everything from pick up and drop off documents to picking up patients at their homes and driving them to their local Medicaid office, assist them during their appointment and then driving them home again.
After working an account in our office we consider it an approval only when the account is eligible and billable to Medicaid. Once it is approved, however, a fee is billable to the client and is not dependent upon the client successfully billing the account and receiving payment. RPM will also provide Medicaid billing services for those clients desiring such service. Naturally, Medicaid billing on behalf of our clients carries an additional fee and requires the client to assume responsibility for all coding issues.
Charity Care Identification and Application Services
In today's healthcare environment, it is more and more important for hospitals and other medical providers to be proactive in identifying accounts that are most appropriately identified and written off as Charity Care rather than going forward with a self pay collection effort with a medically indigent patient. As the state Medicaid programs continue to experience cut backs in coverage the numbers of patients that have no health insurance and no means for paying the bill continues to grow. RPM's Charity Care program is modeled after our Medicaid eligibility program in that the resources needed to assist patients in gathering documents to establish entitlement to a charity care write off are readily available for those clients looking to proactively meet its' charity care goal. While a majority of hospitals have historically operated in a purely reactive mode in awarding charity care discounts, the current negative public relations and litigation against not for profit hospitals suggests that hospitals will eventually need to outsource the function of identifying and processing charity care applications.
RPM anticipates that over the next one to two years hospitals will begin outsourcing their charity care process to the same degree that most hospitals currently outsource their potential Medicaid eligibility application process. RPM's Medical Assistance Application resources are prepared to meet this need as the market begins to grow and evolve.
RPM also offers less resource intensive charity care programs from simply mailing out a charity care application to potential patients to completing but not verifying a charity care application. The latter service is often provided to many of RPM's Medicaid eligibility clients.
RPM can incorporate Charity Care identification into any of the Accounts Receivable Programs that we offer our clients. We work with our clients to determine what approach they prefer us to take with respect to Charity Care. This may be as simple as using specific close codes that would help our clients to identify opportunities for Charity Care on the accounts that we have closed or it may mean RPM actively screens accounts based on the hospital's Charity Care guidelines and taking accounts through the application and document gathering process. The importance that the hospital places on identification of Charity Care and the internal resources that hospital is willing to expend determines the type of Charity Care program RPM can provide.
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