Retroactive eligibility, a feature of Medicaid that has been around for decades, has just been eliminated in Iowa, as well as Arkansas, Indiana, and New Hampshire with New Mexico considering now too.
What is Retroactive Eligibility?
If an uninsured patient receives care, the health system can qualify the patient for Medicaid, enroll the patient, and if approved, seek reimbursement for that visit for up to 90 days following the initial visit.
Why does this retroactive reimbursement process exist today?
According to the staff attorney to the Tennessee Justice Center, retroactive coverage “can compensate for the sorts of errors and lapses that can so easily occur on the part of both the applicant and the government bureaucracy” that delay applications. Simply put, 3.8 million Medicaid patients drop from coverage monthly even though they still qualify.
What is the impact on revenue from removing retroactive eligibility?
If you have been enrolling patients at point-of-care for Medicaid, your revenue will decline with certainty. Healthcare providers and consumer advocates also fear that it will leave patients and hospitals with hefty bills and a poorer patient experience.
So what can you do?
Proactive coverage management. Implement a system that allows you to identify when patients drop from coverage so your health system can better represent the patient and keep them insured. Health systems using PointCare’s Total Coverage Management platform are experiencing more covered visits and significantly reducing the need for retroactive reimbursements. This is a nice hedge against the ever-changing coverage landscape.
More about PointCare
PointCare’s Total Coverage Management platform simplifies the qualification and enrollment process with automated approval and lapsed notifications. PointCare allows your staff to manage the data and documents involved with enrollment, all in a secure, HIPAA-compliant environment.
Removing retroactive reimbursement is only the beginning of the changes we are bound to experience with Medicaid. PointCare helps you weather this ever-changing landscape of health coverage. Within our platform you will be notified if a patient falls out of coverage and our software provides the workflow to get them re-enrolled in advance of a visit.
Qualify, enroll, and retain patients with PointCare - so with or without retroactive eligibility, your revenue will remain intact.