Medicaid Revenue Cycle Management (MRCM)
IHMS is pleased to introduce the most comprehensive Medicaid (includes AHCCCS & Medi-Cal) revenue enhancement program in the healthcare industry. The object of this program is to identify potential Medicaid reimbursement from the self-pay population at any given hospital, over the lifetime of the account. Once identified, these accounts have a Medicaid claim perfected and billed to the appropriate Payer. Additionally, the newly discovered Medicaid accounts are evaluated for Medicare Disproportionate Share (DSH) inclusion and recalculated in the hospital's Medicare Cost Report. In so doing, the Hospital may be eligible for increased reimbursement if the date of "notice of program reimbursement" is within three years of recalculation or if a Medicare appeal has been filed and is jurisdictionally valid. The program may also prospectively increase Medicare reimbursement through concurrent data matching of Medicaid Enrollment files. The net result is an increase in Medicare and Medicaid revenue with a corresponding decline in self-pay and bad debt.
This program is unique in the way that it is delivered to your facility. Using a combination of our Medicaid Eligibility Programs coupled with our Retrospective and Concurrent DSH Review, we have created an effective process to enhance your Medicaid Reimbursement. Any and all of these pieces of the Medicaid puzzle can only help you maximize reimbursement and achieve improved results.
Key Benefits
- Increase in Medicare & Medicaid Reimbursement
- Reduction in Self-pay
- Reduction in Bad Debt
Capabilities
IHMS may implement the entire program or only pieces of the program. We work closely with our client to create a program with the appropriate pieces that are beneficial to you, the provider.
- Data Matching
Working closely with your Information Systems Department IHMS facilitates the matching of your patient data to Medicaid/AHCCCS/Medi-Cal enrollment data effectively identifying cases not included in your original DSH calculations. Using current data, IHMS can provide a concurrent matching process that insures that all data is included in current DSH calculations.
- Billing
By matching current patient data to current state enrollment data IHMS rebills previously unbilled accounts effectively maximizing reimbursement.
- Eligibility
Through an electronic or manual referral process IHMS is able to implement a full Eligibility program to augment both the retrospective and concurren DSH review process.
If you have any question fill out our Contact Form
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