From an outsider’s perspective, it would seem as if medical providers shouldn’t be experiencing financial strain. People are more interested in caring for their health. A large generation — the Baby Boomers — are increasingly in need of extended care, with GenX not far behind. And with consolidation, hospitals are seeing less competition, not more.
Yet hospitals and medical providers today are struggling between higher operating costs and an increase in older and sicker patients. More importantly, providers are stuck between caring for those in need and an increase in those simply not able to pay their medical bills.
Facing the greatest risk are federally funded healthcare centers. Because of their unique nature, these federally funded facilities, also known as Federally Qualified Health Center or FQHCs, receive grants from the Bureau of Primary Health Care to serve the uninsured and under-served members of the community with their healthcare needs.
Unfortunately, these grants don’t fully offset the costs of healthcare for these at-risk groups. Complicating matters more, the numbers of self-payers are increasing. As a direct result, federally funded healthcare providers have a higher potential for lost revenue in an industry that is already struggling.
What some of these FQHCs may not realize, however, is that there are ways to recover revenue with retroactive Medicaid. Recovering funds with retroactive Medicaid does come with its own unique set of challenges and hurdles. Yet these issues can be addressed and result in substantive revenue recovery.
The Growing Threat of Self-Pay Clients
In recent years, the number of self-pay patients has increased. Some facilities are seeing a rise in uninsured patients while also seeing a drop in those covered by Medicaid. As factors overlap, causing the decrease in insured patients, these federally-funded medical centers still maintain their commitment to those in need.
Without the gap in funding being filled by Medicaid or insurance, however, these FQHCs will have a hard time maintaining continuity of care. It’s crucial that medical professionals focus on collecting from uninsured patients or those with balances that insurance hasn’t covered if these healthcare providers hope to stay afloat.
Why? While FQHCs may never see 100% of what is billed, there are a few self-pay patients whose bills make up a significant portion of that category of revenue. In fact, roughly 30% of uninsured patients or those with out-of-pocket costs make up 80% of a hospital’s self-pay revenue. Recovering even a portion of those payments can be instrumental in a federally funded medical facility maintaining their ability to care for the under-served.
There is good news for these facilities, however. There are strategies and means for FQHCs to recover revenue that might otherwise seem lost.
Retroactive Medicaid and the Self-Pay Patient
Studies have found that some patients with bad debt actually have billable coverage, including those who don’t receive benefits until after their care has occurred. One way for federally funded healthcare providers to recover this revenue is by identifying patients who receive Medicaid after their visit or procedure is done.
Known as Retroactive Medicaid, the program allows for a patient’s bills to be covered with Medicaid dollars even if the patient didn’t receive coverage until after the bills were incurred. The key is identifying these patients after the fact and within the Medicaid timely filing period.
Finding these patients can positively impact revenue, especially for high-risk facilities like FQHCs who handle many more self-pay patients than other providers. The benefits of the revenue recovery far outweigh the challenges. Plus, there are ways to simplify the process.
Recovering Revenue for FQHCs
Recovering funds from self-pay patients may seem daunting. Some FQHCs are hesitant to go after retroactive Medicaid because the process can be time-consuming and processing refunds for amounts paid can seem complicated.
The process requires identifying patients that receive full Medicaid benefits long after a visit or procedure, updating and submitting the claim for reimbursement , and, in some cases, refunding the patient’s sliding fee payment. For federally funded facilities who may already be operating with limited staff, the additional overhead may seem like more trouble than it’s worth.
However, technology can eliminate the heavy lifting involved in identifying self-pay patients who eventually receive full Medicaid benefits . The right solution can automatically monitor these types of encounters to capture the moment their eligibility status changes, at any point within the legal time limits allowed under the retroactive Medicaid rules.
Healthcare providers risk severe hits to their revenue as the number of self-pay patients increase. At the same time, the number of self-pay and under-insured patients is likely to grow. Federally funded healthcare providers are at an even greater risk for revenue concerns because of the types of patients they care for. But there is a solution.
Retroactive Medicaid can and does help these FQHCs recover lost revenue. The important differentiator for these providers is the right technology. With a turnkey solution that can identify eligibility long after the patient leaves their facility, RetroCAID® automatically monitors the eligibility status of every self-pay and sliding fee encounter within your system on a daily basis. Every self-pay and sliding fee encounter is scrubbed daily for 365 days or until it expires past timely filing. With no integration or remote access needed and no long-term contracts, we don’t get paid unless FQHCs get results. Never Miss another retro-eligible opportunity again! See how much retroactive Medicaid reimbursement your FQHC can anticipate in as little as 24 to 48 hours by contacting us for a free consultation.
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