VOL. 2, ISSUE 4 | SEPTEMBER 2023
Medicaid Continuous Enrollment Concludes: Strategies to Support Patients and Optimize Revenue
During the early stages of the Coronavirus pandemic, Congress enacted the Families First Coronavirus Response Act. This legislation included a provision to maintain Medicaid eligibility in exchange for enhanced federal funding during the public health emergency (PHE). As a result, Medicaid enrollment grew by 25% between 2020 and 2022, and the uninsured rate dropped. In December 2022, as part of the Consolidated Appropriations Act of 2023 , Congress delinked the continuous Medicaid enrollment provision from the PHE, effectively ending the continuous enrollment requirement on March 31, 2023. States are responsible for establishing plans for redetermining Medicaid eligibility, and some states have already begun disenrolling people deemed no longer eligible or unable to complete the re-enrollment process. Operational and financial impacts
The XiFin team conducted an analysis to understand the impact of the end of the continuous enrollment mandate on our customers. Overall, we found that 8.5% of our customers’ accession volume is in payor groups that include “Medicaid” in the name . This analysis also identified several XiFin customers with twenty percent or more of their claim volume from payor groups with “Medicaid” in the name. Laboratories and other diagnostic providers can expect to encounter challenges stemming from the increase in patients no longer insured with Medicaid, including patients unaware they have lost coverage. This will likely cause an increase in AR days and bad debt. It will also cause an increased administrative burden for many providers related to verifying insurance coverage, navigating different billing procedures, and assisting patients with eligibility determinations. Strategies to support patients and maintain revenue Fortunately, there are strategies to help mitigate some of these challenges, support patients, and optimize revenue. 1. Monitor Payor Mix and Understand What Percentage of Your Business is Medicaid Leverage XiFin Business Intelligence (BI) reports to compare your current Medicaid percentage to pre-pandemic levels. Expect your Medicaid percentage to return to the pre-pandemic levels over the next year–unless other significant changes affect your payor mix. 2. Determine Patient Insurance Eligibility Before Billing Use insurance eligibility verification services before billing to reduce the time to collect. Sending a claim to Medicaid for a patient no longer eligible for Medicaid benefits slows down your collection cycle. It is easy to turn on Medicaid eligibility determination in XiFin RPM.
Resources to Support Patients and Maintain Revenue
3. Leverage Automated Insurance Discovery Use tools that can verify that the insurance provided is correct and, if incorrect, help identify if the patient has updated insurance before billing. Automated next actions can be set up in XiFin RPM (based on reason codes) to streamline this process. XiFin RPM also provides built-in match/auto-match capabilities that identify and automatically update patient demographic information based on existing paid claims in the system. The system also provides match-compare functionality that will present, based on customer-specific configuration, claims that the user can review and, where appropriate, use to update information on a claim. Learn more about XiFin’s insurance discovery partners , FrontRunner Healthcare and WaveHDC, and if you are interested in learning more, request a meeting via your CSM/CAM. Reach out to your Customer Success Manager (CSM), or your Customer Account Manager (CAM) if you are an outsourced billing services customer, for assistance accessing any of the following resources: ■ Selecting or activating an eligibility verification service ■ Choosing or turning on insurance discovery services from one of XiFin’s insurance discovery partners ■ Accessing client profitability or other business intelligence (BI) reports ■ Selecting or activating an interactive voice response (IVR) system offered by one of XiFin’s partners
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