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CBIZ’s Out-of-State Medicaid Billing Nets $400,000 for One Health System

Billing out-of-state Medicaid patients presents numerous challenges due to the variations in rules and requirements across different states. Learn how CBIZ helped one system navigate through these complexities.

July 2023

By: Adam Abramowitz, Senior Manager, Sales and Marketing

The challenges for billing out-of-state Medicaid patients are manifold. At the top, each state has different rules for billing its Medicaid program. And as a corollary to that, each state has different credentialing rules in order for an out-of-state organization (and/or a physician) to even be able to bill. Furthermore, once the credentialing has been established and an organization can bill, the various states have different timelines and requirements for a billed claim to be paid.

So why bother then? Well, the money.

CBIZ has already brought in over $400,000 for one health system in 2023 with our out-of-state Medicaid billing service and we are on track for $700,000 by the end of the year. We’ve been able to credential and bill for them in seven new states. Almost all of this revenue in prior years would have been written off.

Our billing for out-of-state Medicaid service highlights the pick-and-shovel work that CBIZ specializes in. Most of these bills aren’t high-dollar claims. Sure, if there was a $120,000 out-of-state Medicaid claim, a hospital would deem that worth its while to get credentialed to bill for this. But what if their out-of-state claims averaged $4,000? Now this is where CBIZ comes in to assist.

Billing for out-of-state Medicaid can be labor-intensive. It requires knowledge of the intricacies of Medicaid on federal and state level. Key revenue cycle components such as billing, coding and responding to denials are also vital in providing this service. Furthermore, it requires persistence and time. CBIZ has utilized its vast Medicaid expertise, on-staff resources and technological infrastructure to increase our clients’ out-of-state Medicaid revenue.

We work as an extension of our clients’ patient access staff. We believe in constant communication with our clients, both pre- and post-bill. We are constantly monitoring for pending payments. And if there are denials, we have the expertise to understand the root causes and to work with our clients to get those claims paid.

If you have a need for assistance with billing out-of-state Medicaid patients, we would welcome the opportunity to talk with you. For immediate assistance, please contact Adam Abramowitz at [email protected] or 609-220-5627.

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