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Why Medicaid Redetermination Should Inspire a Re-Evaluation of Your Self-Pay Management Strategies

UPDATED:
August 17, 2023
Re-Evaluation of Your Self-Pay Management Strategies main

Medicaid redetermination is finally upon us. In case you missed it, federal regulations are now in place that allow states to reinstate an annual Medicaid re-enrollment requirement after three years of suspension. As a result of this redetermination process, an estimated 6.8 million people are set to lose their coverage despite remaining eligible. 

The tough pill to swallow is that we’re only two months into a 12-month redetermination process, and already over 1.6 million people have lost coverage, indicating the initial 6.8 million estimate may be understated. 

Some hospitals and health systems, along with their state counterparts, have already taken proactive steps to manage redetermination and keep patients enrolled without a lapse in coverage. However, while these efforts are excellent and highly recommended, the reality is that hospitals should still expect an increase in self-pay patients this year and next. 

Now is the time to shift focus and start to strategize how your hospital or health system will effectively manage the influx of these patients. Reevaluate your self-pay process and how you’re utilizing both internal resources and external resources. You may find clear room for improvement and a change in process.

Are you prepared?

The estimated 6.8 million patients (or more) set to lose coverage despite remaining eligible likely enrolled during the Public Health Emergency, when re-enrollment requirements were suspended. They may not know they have to re-enroll or don’t know how to begin to navigate the process. Some patients are already losing coverage based on administrative issues, like having the wrong address on file or missing a deadline they may not know existed.

For a few reasons, it is in the best interest of both the patient and the hospital to re-enroll in Medicaid before coverage expires rather than enrolling again after a lapse in coverage. For the patient, it means retaining coverage without possibility of a stressful pile-up of medical bills or concerns about how they will pay for care while in the hospital. For the hospital, it means the patient’s account balance will be covered and, without the added stress of medical bills on the patient’s wellbeing, the care team can see a higher rate of success. 

It’s also generally much easier on both sides to re-enroll someone in Medicaid than start from scratch as newly eligible. It takes fewer human resources and less time and back-and-forth with the patient. 

Are your current processes and systems set up for increased proactive outreach, re-enrollment and influx of self-pay patients? If there’s room for improvement, you have two options. You can either increase or continue reliance on external resources, or you can improve processes internally. 

Strategy One: Using external resources

Many hospitals and health systems leverage third-party vendors to manage self-pay patients. If this is the case, hospitals, and subsequently, vendors, will certainly see an increase in patient accounts this year.

Most vendors operate on a contingency fee on a per-patient basis. You are expected to carry the cost of Medicaid enrollment with these vendors. While it’s extremely convenient, vendor engagements are often expensive. This cost will only increase throughout redetermination.

Vendors also likely will not focus on re-enrollment. As discussed, it’s more time and cost intensive to newly enroll patients rather than renew, further increasing the cost of relying on external resources.

For some hospitals, vendors may be a wonderful solution which takes pressure off internal financial counseling teams. But for others, the cost of doing business during redetermination may prompt a closer look at what can be done internally. 

Strategy Two: Maximizing existing internal resources

It is possible to maximize your existing, internal hospital-based self-pay management resources to cut costs while maintaining Medicaid patient coverage. Your team just needs the right tools and processes in place to foster success.

A good software tool can partially or fully take the place of a third-party vendor and prioritize re-enrollment over renewal. With software, financial assistance teams can:

  • Increase productivity by streamlining and automating processes.
  • Discover when patients are enrolled or eligible for Medicaid and hospital assistance programs, allowing hospitals to renew rather than re-enroll. 
  • Provide ongoing coverage management.
  • Maximize revenue while ensuring compliance.

The tools and processes you currently have in place may not be scalable to a level necessary for managing redetermination. In this case, the best solution to maximize internal resources is MAPS, an all-in-one self-pay patient management platform. 

More on MAPS

Using the MAPS platform you can significantly improve traditional manual processes, enforce workflow standardization, and optimize patient tracking and coordination. Its key features revolve around maximizing both revenue and process efficiency without placing more work on already-strapped teams. 

  • 15% increase in recovered revenue
    MAPS rapidly identifies patients that have existing coverage and connects uninsured patients to the correct programs quickly and automatically, reducing the cycle time on Medicaid enrollment. From there, MAPS provides data capture designed to comprehensively screen the entire family for eligibility in a process that is highly configurable and adaptable to your organization’s structure and needs. Applications for identified programs can be submitted electronically via a secure, proprietary exchange interface.
  • 25% increase in process efficiencies and accuracy
    With automated data flows, documentation, notes and adjustments, MAPS provides a rule-based enrollment program to enforce standards and determine the correct enrollment pathway from among Medicaid, Financial Assistance, SNAP, TANF, and other community and social services-based assistance programs.
  • 15% increase in resource optimization 
    The MAPS-clear Patient Portal ties the entire all-in-one solution together by providing patients with self-service tools for screening and enrollment and a source of one-to-one communication with the financial assistance team. With the MAPS platform, the team can also ensure its own compliance, better assist patients and improve performance with case management, tracking and reporting across the enterprise. 

Do you have the tools, processes and systems in place to effectively manage Medicaid redetermination and the resulting influx of self-pay patients? It’s not too late into Medicaid redetermination - now is the time to reevaluate and make changes to maximize the potential power of your internal team. 

Contact Office Ally today for a free demonstration of MAPS features and consultation on how they can meet your organization’s individual needs.