Out-of-state Medicaid Claims Revenue Recovery Service
Many providers find that billing out-of-state Medicaid requires so much effort that they ultimately decide to not bill these claims and write them off.
Would you like to achieve any of the following?
- Fewer write offs for out-of-state Medicaid claims
- No need to complete lengthy and complicated out-of-state Medicaid enrollment applications
- Experienced experts monitoring the out-of-state Medicaid enrollment status
- No longer worrying about maintaining and updating out-of-state Medicaid provider numbers
- No need to track state-specific authorization, billing, resubmission, and appeal requirements
- Clean out-of-state Medicaid claims submitted within timely filing requirements
- Not having to retain niche Medicaid expertise as employees come and go
- A fully-integrated out-of-state Medicaid enrollment and billing process that reduces the risk of missed revenue and denied claims
- More time for your PFS staff to focus on their core competencies of government and commercial claims
If so, Argos Health can definitely help.
Juan Seijido, Director Patient Accounts, Memorial Sloan-Kettering Cancer Center
Argos Health has been providing out-of-state Medicaid enrollment, billing, and collection services for over twenty years. We’re experienced with all state Medicaid plans.
Our clients often see an increase of over 50% in out-of-state Medicaid payments once we take on the work. How do we accomplish this? We operate as an extension of your business office and bring our detailed knowledge of the regulations and requirements of 50 different Medicaid programs. We handle this work for over 140 hospitals, and that means we’ve already experienced the difficulties and challenges your employees have been facing when attempting to obtain reimbursement for these claims.
We can also address your Medicaid prior authorization needs. We submit the necessary payer forms, follow up to confirm proper processing, and manage all requirements and submission destinations. This reduces authorization denials and leads to faster payments
What are the Greatest Challenges Related to Out-of-state Medicaid Claims?
Here are the biggest challenges faced by hospitals when it comes to pursuing out-of-state Medicaid claims on their own.
Consider the effort required to stay up-to-date with Medicare regulatory changes. Now multiply that by 50. Then add the numerous Medicaid managed care plans States update Medicaid program rules, regulations, processes, and policies regularly. Unless you’re enrolling providers with and billing claims to a state regularly, it’s nearly impossible to maintain the knowledge required to submit clean claims and get them paid. Argos Health works with all 50 states and has developed processes and relationships to remain up to date as the programs evolve.
State Medicaid programs require that hospitals, health systems, and providers be enrolled in the program before claims may be submitted and paid. Under the Affordable Care Act, even physician providers listed on claims (Ordering, Prescribing or Referring) must be enrolled for screening purposes before the facility claim can be paid. The physician enrollment can be a non-reimbursement / non-billing enrollment. Without a well-designed system to manage initial enrollment, maintenance of provider numbers, and associated credentialing, this can be a daunting task.
The enrollment process can be very cumbersome. While some states are making strides to ease the enrollment burden for out-of-state providers, they remain the exceptions. Most states require detailed confidential disclosure information for enrollment, such as Social Security numbers and addresses of board members, copies of provider drivers’ licenses, etc. Internal hospital resources may balk at even asking for these items. Argos Health has developed communication techniques that help the individuals involved understand why the enrollment process is critical. In many cases, board members and physicians are more comfortable providing this information to a trusted third party.
Provider Applications and Enrollment
Argos Health enrolls your facility and physicians in state Medicaid programs and HMO plans as required for billing. All enrollment documents are completed in full by our staff and sent to you for review and signature, making this process effortless for you. Provider numbers are updated and maintained with the states, thereby reducing provider-related claim denials.
We confirm patient eligibility and determine timely notification requirements.
Our staff informs our clients of any payer authorization requirements for the service being billed.
Billing and Follow-up
Our sophisticated system edits ensure compliance and quality control. Claims are submitted within timely filing requirements to the proper payers.
We provide specialized month-end reports for your easy reconciliation, including claim inventory, payments, and invoice summaries.
Argos Health submits claim and payment appeals when applicable and represents your hospital in subsequent hearings where allowed.
The Argos Advantage
Argos Health sets itself apart from the competition by accurately and diligently working all out-of-state Medicaid claims from beginning to end, regardless of the ultimate source of payment or challenges along the way. Here’s one example:
A hospital in New York billed a Medicaid plan in Connecticut for a 9-month inpatient stay ($5M+ in charges). The payer claimed to have no record of prior authorization on file. The hospital had documentation of attempts to obtain prior authorization. The payer denied the claim multiple times. Argos Health appealed several times, citing Connecticut regulations and providing justification based on Argos’s knowledge of past Connecticut decisions.
The claim payment was approved, and the hospital received over $1.3M.
Out-of-Sate Medicaid Revenue Recovery Service Video
Watch the video below to learn more about our out-of-state Medicaid service.
Out-of-State Medicaid White Paper
Out-of-State Medicaid Claims: From Afterthought to Revenue Opportunity
Out-of-state Medicaid claims present a unique challenge for healthcare providers. No other claim type requires such broad knowledge of regulations, IT systems, and government processes to bill and collect correctly. However, the often high-dollar emergency and specialty treatments associated with these claims make it worthwhile for providers to identify a solution.
The white paper covers the following topics:
- Background information on out-of-state Medicaid coverage
- The impact of ACA Medicaid expansion
- Why many hospitals have more out-of-state Medicaid claims than they might think
- How out-of-state Medicaid claims can affect Medicare bad debt calculations
- The enrollment and authorization processes
- Challenges related to billing, follow-up, and denial management
- And more…
Download our white paper to learn why out-of-state Medicaid claims can present a real revenue opportunity for hospitals and health systems.
Click here to download our out-of-state Medicaid sales sheet.
How much do you charge for your out-of-state Medicaid service?
We have no implementation fees or startup costs, and we perform all work on a contingency basis. Our rate is determined by claim volume and how you’d like us to customize the enrollment process. A quick conversation can usually allow us to obtain the information required to quote a very competitive rate.
Why can you get out-of-state Medicaid claims paid better than my hospital staff?
We have a large staff, 100% focused on out-of-state Medicaid billing and collections. They don’t have other responsibilities like the person assigned to this task at your hospital probably does. Many of our employees have very long tenure, and with out-of-state Medicaid, experience counts for a lot.
Can you handle out-of-state Medicaid claims that we’ve already written off?
Depending on the program rules of the states involved, we may be able to pursue claims up to one year old, even if you have already written them off.
Our providers, administrators, and board members will never want to provide the information needed for Medicaid enrollment. How will you handle this?
We see this initial reaction very often. Our approach is to educate the relevant individuals on the benefits to the hospital, along with the state and federal regulations that create the enrollment requirements. We can also connect them with other customers that can provide evidence that the financial impact is well worth the initial enrollment effort. We’re willing to come in person to customer sites to answer questions and provide more information as needed.
Can you provide references?
We’d be glad to have you speak with our happy customers. We have client relationships that go back over twenty years. We work hard to keep our customers satisfied.
What other complex claims services does Argos Health provide?
We offer other complex claims services besides out-of-state Medicaid claim billing and collections. This allows a hospital to centralize the management of multiple types of challenging claims with a single vendor. Many clients recognize the advantage this provides, since a complex claim may start down one path (VA, third party liability, workers’ compensation, out-of-state Medicaid, etc.) and end up being paid by any number of payers. Once we are referred a complex claim, we’ll pursue whichever payer is appropriate until all revenue is recovered.