Retroactive Medicaid Enhancement
IHMS is pleased to introduce our Retroactive Medicaid Enhancement (RME) Program. The eligibility process for Medicaid can be both cumbersome and lengthy and hospitals are forced to make cost/benefit decisions with regard to the level of resource assigned to each account it pursues for recovery. There are many opportunities to convert self pay classified accounts into Medicaid claims that in the past have not been cost-effective. IHMS has developed a targeted program to identify, bill and recover upon a category of accounts which have historically gone unaddressed.
IHMS has been a leader the Medicaid eligibility field since its inception in 1996. During that time, we have converted nearly $100 million in self-pay charges into paid Medicaid claims. It is in this tradition that our RME program has been launched in an effort "to leave no stone unturned".
The RME program accepts small balance (typically less than $500) in self-pay accounts over a prior period of six months. Using data matching technology, IHMS checks these accounts against the Medicaid Program Enrollment files to identify which had Medicaid Eligibility at the time of service, but were never billed to the Medicaid payer. After identification, IHMS bills and follows up on these claims until payment has been received.
This program works equally well for the AHCCCS program in Arizona, and for Medi-Cal in California.
Key Benefits
- Increase in Medicaid Dollars
- Reduction in Self-pay
- Reduction in Bad Debt
Capabilities
IHMS uses data matching technology to identify accounts meeting criteria under this program with a minimum interruption to the provider's normal course of business. The process is quick, efficient, and maximizes reimbursement to the facility.
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