Medicaid Expansion – Clinic Expansion

Categories: Billing, FQHC, PMG Insights Blog

October 21, 2013

The Supreme Court’s ruling on the Affordable Care Act (ACA) allowed states to opt out of the portion of the law that covered states’ Medicaid expansion. What has your state decided? If your state has decided to participate in the expansion, are you ready?

There are fewer than 100 days left before the exchanges launch! How will your clinic handle the change? While many clinics are claiming they are ready, it is not clear if the implications for the front desk, the clinical staff and the billing office are fully understood.

While the overall effect of more insured patients may have a positive impact on the revenue cycle, that impact will take some work. Additional work requires additional staff members. More insured patients may mean a greater demand on provider resources. Do you have capacity within your clinic to handle an influx of new patients? Have you earmarked any staff members for community outreach in getting patients enrolled in the insurance carriers on the exchange?  Having the benefits available to the community does not always mean compliance and a working knowledge of the benefits.

Finding the time in the day of a front desk staff member for insurance verification is not always easy or possible. What will we do when even more patients require eligibility and benefit verification? We all know the battle is won or lost at the front desk. Without accurate insurance information, a claim’s chances of being paid are minimized.

Sending out a patient statement for a “self pay” or “sliding fee” patient takes far less work than getting a clean claim out the door and getting it paid. The reward for a paid insurance claim may be greater but so is the work load and knowledge needed to do so. Is your billing department prepared for the increased volume?

Start dissecting the data. What is the volume of active uninsured patients? What portion will be eligible for insurance through the exchange? We have all the demographics and the income levels from our sliding fee patients. We should use it to be strategic. FQHCs have an opportunity with the ACA, we need to allow it to increase our presence in the community not crush us in the administrative burden of it all. Don’t miss out! We still have 100 days! Let’s get ready.