Medicaid Enrollment-Enrolling Hospital Patients
Each year hospitals and health clinics lose billions of Medicaid dollars from:
- Time consuming business processes
- Lack of automation
- Insufficient follow up
Each day, medical billing staff are tasked with enrolling, verifying and capturing Medicaid patients. The process of getting patients enrolled into Medicaid can seem simple but the process is cumbersome and reliant on the accuracy of a previous process. Let me walk you through the process and outline some of the complexities for you.
How to Start the Enrollment Process
There are two ways to begin the enrollment process online. Most states also offer a paper application that can be completed then mailed or faxed in. In general, applying online is going to get quicker results. It also has the benefit of getting completed while the patient is in the office. If you rely on them to complete and send a paper application at home, there's no guarantee the application will be sent in. Use Benefits.gov to find your state’s programs and find the right way to apply.
Remember that previous process I mentioned. It’s called Patient Registration and it happens before Medicaid enrollment? Patient registration accuracy is important. If a date of birth or SSN is transposed, the Medicaid enrollment specialist will pass that inaccuracy to the Medicaid enrollment system. This data entry error could delay coverage for the patient.
The eligibility process can also be delayed when clients need to provide proof of income (usually through pay stubs or tax returns) or employment (generally through forms signed by employers). In many cases, however, hospitals can use presumptive eligibility to get patients benefits right away.
Will the Patient Be Automatically Eligible for Medicaid?
In some states, presumptive eligibility can help clinics get patients enrolled right away so they can bill for that day's visit. Generally, people that meet the federal poverty-level [link: United States Federal Poverty Level] or pregnant women can get a presumptive enrollment while their application is processed.
People who receive SSI are also automatically eligible for Medicaid from the date of their eligibility determination for social security benefits.
What Happens After the Enrollment?
If a patient is presumptively eligible for Medicaid, then all covered services will be paid for between the time that eligibility is determined and the final eligibility determination. Once the patient has been enrolled, however, they do need to complete a full Medicaid application. This can require income verification and proof of employment, depending on the state’s specific regulations. When clinics are manually attempting to keep up with Medicaid applications, this process is incredibly cumbersome.
If the patient is not presumptively eligible and needs to complete a standard Medicaid application, and then qualify for benefits, it is sometimes possible to qualify for retroactive benefits. If approved, this will often allow patients to be eligible for coverage up to three months before their application date. In these cases [link: Can a patient apply with Medicaid if their presumptive eligibility claim is denied?], completing a manual application with the client and then helping them follow up may be in the clinic’s best interests.
These enrollment changes make it hard to capture in a billing setting. The medical biller may have a denied presumptive eligibility claim and move the account balance to patient responsibility. In the meantime, the patient could reapply with Medicaid. He may even become retroactively eligible but if, the patient forgets to tell the hospital or clinic, the unpaid account may eventually end up written-off to bad-debt or timely filing.
What Keeps Hospitals or Clinics from Capturing all Medicaid Enrollees?
Unfortunately, staffing and time issues are one of the biggest reasons that hospitals and health clinics miss out on Medicaid dollars. Staff may feel that they don’t really understand how to work with eligibility programs, or they believe that the process is too time-consuming.
While both of these things can be true, automation can help make the process much simpler. Instead of having social work staff contacting customer service with a long list of patient numbers, or a long list of patient calls to double check [Link: Do patients jump in and out of Medicaid coverage?], automation can move the process more quickly.
Try automating your Medicaid eligibility to see your hospital or health clinic’s free time skyrocket, allowing enrollment specialists and social workers to do more with their day.