AAHAM Annual National Institute Roundup

November 2022

By Adam Abramowitz,  Senior Manager, Sales and Marketing

CBIZ KA Consulting Services, LLC exhibited at AAHAM’s Annual National Institute (ANI) last month in Baltimore. This was the organization’s first annual conference since 2019. CBIZ has been a proud supporter of AAHAM for well over a decade and we’ve always found the ANI to be a great opportunity to meet and network with patient financial services and patient access professionals.

Over the years, the purview of many AAHAM ANI attendees has expanded. Whereas many attendees used to be primarily focused on billing, payment and collection issues (with a large emphasis on Medicaid eligibility), we now have frequent conversations about additional aspects of the revenue cycle. This trend continued in 2022.

This year the main topic of concern for many attendees was denials. With payers aggressively targeting hospitals with DRG Downgrades/Clinical Validation Denials and Medical Necessity Denials, many hospitals and health systems are struggling to manage their internal denials process. In talking to many attendees at the conference, hospitals are lacking resources to respond to these denial types in a timely fashion and to appeal the ones where they have a reasonable expectation for overturning them.

Although denials have been an issue for providers for decades, the volume of the DRG Downgrades, for example, and the payers’ success in identifying documentation that doesn’t fully support a specific billed service have changed the game. Where once providers and payers had collegial relationships in resolving these issues, now the tone has often become more adversarial. Many payers have enlisted third parties on an incentive basis to recoup money. Hospitals need to understand that this new wave of aggression regarding denials and downgrades isn’t going to stop. Providers must evaluate their internal processes to examine root causes of their denials, fix these issues going forward, and appeal their winnable denials in a timely fashion. Big money is in play!

At the ANI, we also had a lot of discussions with attendees regarding out-of-state Medicaid eligibility. For many providers (and their vendors), this patient pool was often ignored. But, three factors have changed the calculus:

• As health systems have expanded, they now have more self-pay patients from states outside of their traditional markets.
• In the current economic climate, more health systems are in “every dollar counts” mode. To them it may not have been worth trying to qualify these patients for Medicaid ten years ago; it is now.
• Virtual technology now exists to make it easier to complete the Medicaid application process for out-of-state patients.

Although many health systems do seem more interested in pursuing this patient population for Medicaid eligibility, it’s not necessarily simple to begin. First off, many state Medicaid plans have an onerous process to initiate billing from out of state. There’s a lot of sweat equity needed to start this process. In addition, health systems need to incorporate the right virtual tools to reach this patient population. Expecting these out-of-state patients to return to your facility to fill out forms is unreasonable; health systems need to acquire the tools and instill the follow up communication processes to help patients complete their applications in a timely manner.

CBIZ was happy to exhibit at this year’s conference and we look forward to attending the 2023 ANI. If you have any questions or needs about the areas mentioned above (denials, out-of-state Medicaid) please contact Adam Abramowitz at [email protected] or at 609-220-5627.