A Medicaid eligibility program requested a complimentary self-pay audit after quantities rose to an unsustainable number of aging receivables. Parallon was able to find 57% of self-pay accounts had opportunity for additional revenue. The result: Parallon was selected as an outsource partner to help increase cash and reduce uncompensated care.

CLIENT

Regional Hospital

FACILITY TYPE

Acute Care Community Hospital | Largest Employer in its County | Serving an Eight-County Radius across Two States

CHALLENGE

The regional hospital was handling self-pay accounts internally. Over a brief period of time, they saw the quantity grow to an unmanageable and unsustainable number of aging receivables.

HOW WE HELPED

Parallon initiated a few self-pay audits that reviewed 537 self-pay accounts including all inpatient accounts and outpatient accounts greater than $10,000. Upon review, we were able to find:

• 28% of accounts had a moderate likelihood for Medicaid eligibility.
• 17% of accounts had a high likelihood for Medicaid eligibility.
• 4.6% of accounts had Medicaid coverage.
• 4.1% of accounts had other active insurance coverage or third-party liability (TPL) eligibility at the time care was provided.
• 2.6% of small balance accounts had active Medicaid coverage.
• 1.4% of accounts had other forms of active insurance.
• 40% of accounts did not appear to have any potential for Medicaid eligibility, third-party liability eligibility or other active insurance coverage.

THE RESULT

Parallon was able to help the regional hospital uncover $4.5 million in collectible accounts that they had not retrieved.

After realizing they needed an outsource partner to assist, hospital leadership selected Parallon based on its demonstrated excellence in business analysis and breadth of service offerings to help them increase cash and reduce uncompensated care.

LESSONS LEARNED

• Stay on top of local rules and agencies for Medicaid eligibility.
• Understand out-of-state enrollment when servicing multiple regions.
• Investigate denied or underpaid complex accounts.
• Invest in support staff and customized technology to focus resources on other accounts.