By Michael Lopez, Manager - Medicaid , Francisco Francisco, Assistant Manager - Medicaid, Adam Abramowitz, Senior Manager, Sales and Marketing
In over 20 years of providing Medicaid eligibility services, CBIZ has always prided itself on its patient advocacy. We do the hard work to ensure qualified patients are enrolled into federal and state programs that will improve their quality of life. In addition, our efforts have been appreciated by our client hospitals. Instead of writing off accounts, we pursue every avenue so that patients are enrolled in applicable programs, which leads to hospitals getting improved reimbursement.
CBIZ has adapted its eligibility services to meet the challenges of the COVID-19 pandemic. In 2020, we introduced our Touch-Free, Patient-Facing Medicaid Eligibility approach, which has enabled us to provide the same level of exceptional service to our clients and their patient populations, whether we are on or off-site. As a result of our new approach, we have maintained our high standard of Medicaid application conversion rates and total client reimbursement, despite significant changes to how we perform our services.
Below are two examples where CBIZ went above-and-beyond as patient advocates during the COVID-19 crisis. And despite changes in on-site personnel and other face-to-face contact, we were able to provide expanded coverage for patients and significant revenue for our client hospitals.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CBIZ received a complex case referral from one of our long-term clients in reference to an uninsured ICU patient who had been hospitalized in 2020 from July 04th through November 18th. Upon initial screening, it was determined that the patient was eligible for Emergency Medicaid services for non-qualified aliens due to his diagnoses and immigration status. The application process required the patient to submit an application to the local county board of social services and provide copies of all the required documentation, such as a valid photo identification, proof of address, proof of income, and/or financial support letter within 90 days from the date of admission. However, in this particular case, the circumstances turned out to be far more complicated than originally anticipated.
Upon admission the patient was in a critical state due to sepsis, gangrene and necrosis of the lungs; pneumonia; and tuberculosis. He had respiratory failure. The ICU medical team was forced to place the patient on a 24-hour mechanical ventilator and inserted an endotracheal airway tube and feeding device in order to sustain his life. In addition, the hospital staff extracted and drained both lung lobes and kept the patient within an airborne isolation room for the duration of the admission until he was medically cleared to receive a lung transplant surgery (this took over four months).
According to hospital records, there were no emergency contacts, no family members and no next-of-kin information available. CBIZ continued to monitor the patient’s prognosis until he was physically/mentally capable of signing application forms, which eventually exceeded the Medicaid filing deadline.
Often times, cases such as this one would be considered by most “so-called” eligibility experts as “dead in the water” or “stuck in the mud,” but we at CBIZ specialize in account resolution by thinking outside the box, utilizing our many years of experience and wealth of Medicaid knowledge to overcome potential roadblocks.
Through determination and a collaborative effort, CBIZ was able to outline the details of this case with the county administrative supervisor, who allowed a late submission of the Medicaid application and even accepted alternative documentation (self-attestation letters) since the patient was not capable or physically able to complete this process within a timely manner. As a result of our follow up efforts, the patient was eventually approved for Emergency Medicaid coverage, which paid the entire admission according to the fee-for-service DRG rates. For the record, the patient account was worth $2.1 million in total gross charges and the hospital received a payment of $218,279.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While stationed at one of our client hospitals during the pandemic, CBIZ had the opportunity to work on a complex Emergency Medicaid case for a patient diagnosed with COVID-19. The uninsured ICU patient was hospitalized from 10/24/2020 through 1/5/2021. From the first day of admission, the patient was placed in isolation; only one nurse per shift was authorized to go into the patient’s room. As the days passed, the patient’s condition got much worse. The patient was eventually placed on a respirator, dealing with pneumonia, respiratory failure, and encephalopathy – a condition that alters brain function.
CBIZ identified that the patient’s condition would most likely have him hospitalized for over 30 days. Initially, it was determined that the patient would exceed the income threshold for Emergency Medicaid, but we kept tabs on the patient throughout his admission. We proactively began our attempt to collect documentation, such as a valid photo identification, proof of address, proof of income, and/or a financial support letter. After 30 days passed, the patient remained intubated and unable to communicate. However CBIZ was able to obtain a next-of-kin contact through the patient’s records. Through the next-of-kin, CBIZ was able to obtain signatures, a statement of support, and proof of address.
However, neither the family nor the hospital had an identification for the patient. CBIZ followed up with the hospital’s nursing staff to obtain the ID from the patient’s room. CBIZ needed to consistently follow through with different nurses, during different shifts, on different days, to be able to check the patient’s belongings in his isolated room.
Finally, CBIZ was able to visit the COVID-19 unit and we were able to speak to a nurse who went into the patient’s room to obtain an identification. It turns out that the patient only had a county-issued ID, but that was sufficient to complete his Emergency Medicaid application with that particular county board of social services.
A common approach with a case under these circumstances would have been to write off the account, especially after it was initially determined that the patient would exceed the income threshold for Emergency Medicaid upon admission. But at CBIZ, we seek the highest level of coverage for the patient, as well as the highest reimbursement for the client. Emergency Medicaid eligibility is determined on a month-by-month basis, so CBIZ used its expertise to think ahead based on the patient’s medical condition. And eventually, the case was approved for Emergency Medicaid.
The key to our success with this patient was our expertise in anticipating that the patient may become eligible for Emergency Medicaid; whereas, many other firms would have discontinued their Emergency Medicaid follow up efforts based on the patient’s initial ineligibility upon admission. Other important factors in this case were the frequency of communication with the hospital nursing staff and the patient’s family, as well as our established relationship with the hospital’s nursing staff – they knew that we always try to do the best for the patient. Thanks to our approach, the Emergency Medicaid case was approved for the full admission, resulting in a reimbursement for the hospital of over $90,000.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
These two examples highlight the lengths that CBIZ will go to in order to enroll eligible patients for federal and state programs. And there are many more cases like these. Combining experience, creativity, positive relationships with hospital staff, patience and expertise regarding county, state and federal rules, CBIZ was able to enroll these patients where many other companies would have failed, or wouldn’t even thought to have tried. But for us, our clients pay us to do the hard work, and the benefit is seeing patients get the coverage they’re entitled to and our hospitals receive appropriate reimbursement for services rendered.
If you have any questions about our eligibility services or how we may be able to assist your organization contact our office at 800-957-6900 or email at kaconsults@cbiz.com.
Copyright © 2021, CBIZ, Inc. All rights reserved. Contents of this publication may not be reproduced without the expressed written consent of CBIZ.