Can you determine if your organization is maximizing the income opportunities from the Medicaid services that you provide?  How would you know?  In this article - we're going to outline some of the things you can be doing to insure you avoid some of the common pitfalls to Medicaid billing.

According to research provided by Open Minds, a leading organization that provides best practices to the behavoiral health and social services communities - two major trends have been observed:

• Organizations in the field are collecting as little as 80% of the Medicaid services that are billed
• Organizations are not billing for many services that are delivered.

There are three key reasons why organizations do not maximize appropriate Medicaid revenues:

• Missed opportunities in service billing
• Service billing coding and procedure problems
• Ineffective collection management processes

All is not lost, however – as just a small increase in both billing and collections can provide much-needed financial resources for staff salary adjustments and the development of new services.

Do You Experience Missed Opportunities in Service Billing?

Do you really know?

There are two steps in reducing missed billing opportunities.  Step one is to really understand your State Medicaid Plan to ensure that your services and programs are Medicaid-allowed services.  There are many ways to find out this information including reading the document on the state website, networking with peer associations, partners and even competitors offering similar behavioral health services.  You could also conduct a review with a state licensing department to assess your organizations programs and services to determine if they meet the requirements for reimbursable services under Medicaid.

Step two is to build your IT infrastructure – for information management processes and systems, but more importantly to be able to track all billing and revenue opportunities through an interactive database.  With the right case/ performance management software – when medical case notes are entered into the system and marked “billable”- they automatically transfer over to the billing portion of the software that has alerts and notifications tied to help prevent missed opportunities. 

Building your IT infrastructure involves purchasing hardware, building networks and running databases, and can come with a hefty price tag.  Child welfare case management software like FAMCare can be completely hosted – so there is no hardware to worry about and no software to install.  It’s virtual… it’s in the cloud and it’s always available.

Another step in helping to reduce missed opportunities for service billing is to make sure you obtain the proper credentialing of the professional staff providing the services to your clients. 

Medicaid has rules that clearly outline what can be considered "billable".  For example - if the billable clinical professionals are not properly “credentialed” according to Medicaid requirements, the services cannot be billed.

Medicaid has strict rules and regulations that clearly define the credentialing standards for billable services. Imagine billing for services and the clinician didn’t have the proper credentials.  When Medicaid says “No”, you lose.  You lose time.  You lose money.  Eventually – it can impact your ability to deliver the services that help kids.  Each time this happens, it’s like an un-treated infection – it can cripple you.  And across the country – this is happening every day.

Again – the right information system can maintain a process for credentialing all the clinicians you work with.  Their credentials can be attached to their records, any documents or licenses can be scanned and uploaded for convenience.  And because of FAMCare’s workflow engine – alerts can be set to notify your organization of missing licensing information prior to any Medicaid billing.

Frustrated With Service Billing Coding, Errors and Other Process-Related Problems?

  
Are you services documented correctly by clinicians?  Is your billing process bullet-proof and do you have an efficient process for quickly getting bills out the door?  Can you easily identify service codes and descriptions that are directly tied to billing codes?  Because many of the codes are standardized – the right child welfare services system can have all of the codes in a database for easy retrieval. 

FAMCare allows for ‘web-services’, which in this case means that all codes can be updated regularly through a data transfer so that billing codes remain up to date.  In addition – a web service can maintain a record that accurately matches service descriptions to billing codes.  This is extremely important as the use of outdated billing codes and/or failure to implement some type of data “synch” system will guarantee both billing and collection errors.

Ineffective Collection Management Processes?

How solid is your collection process?  Do you have a systematic approach to managing your collections?  As an ex-collector, I know personally the frustrations of maintaining a consistent bottom line - without the use of a good collection process.  Having a good collection management process as a foundation is essential in finding critical problem areas that may cause loss of revenue.  Without a good system - your efforts will be inconsistent and your communication and follow-up with suffer - all leading to bottom line worries. 

With FAMCare - your agency can have your policies defined and timeframes for follow-ups automatically set – to prevent inconsistency in collection efforts.  When these are closely monitored and a workflow for alerts is defined - appropriate action can be taken in a consistent and timely manner.

Your ability to maximize Medicaid revenue is directly tied to keeping your team in front of your data and having a built-in workflow that “drives” everyone in the right direction.  Workflow that can automate even the most "tedious" of processes allowing you to be on top of your game.  Even recouping 5% more revenue could have a significant impact on your company.  Couple that with keeping a close eye on expenses – you can really help your organization improve your bottom line – which is mission critical in these volatile economic times.