Increasing Revenue With Retroactive Reimbursement from Self-Pay Patients

Caring for Self-Pay Patients

Healthcare is expensive and for millions of Americans, it’s a struggle to afford health insurance. While the Affordable Care Act has made progress in providing lower-cost health insurance to the American people, there are still some who are uninsured. Some cannot afford plans on the marketplace, but aren’t eligible for Medicare/Medicaid. 

According to the United States Census Bureau, in 2017, 28.5 million Americans did not have health insurance at any point during the year. Between 2016 and 2017, the percentage of people without health insurance coverage increased in 14 states. Working-age adults, aged 19-64 were 84.6 percent of the uninsured.

These statistics add up to many Americans paying out-of-pocket for their doctor’s visits.

The number of self-pay patients is continuing to grow as health insurance costs rise, yet many primary practices refuse to provide care for them. Medical practices typically never recover 81% of self-pay net revenue, and self-pay patients default on their bills at a 30% rate.

It seems to be a lose-lose situation for both patient and practitioner. Patients struggle with bearing alone the costs of prohibitively expensive medical services that are necessary for their health and doctors provide care but aren’t paid for their services.

Benefitting from Self-Pay Patients’ Retroactive Medicaid Coverage

But it doesn’t have to be – for many self-pay patients, Medicaid eligibility status can change at any time.

Say for instance, a patient is not covered by Medicaid and comes in for a medical service. If the patient’s Medicaid eligibility status changes later on that year, that service can then become eligible for retroactive reimbursement through Medicaid.

Medical practices are likely to care for many self-pay patients, and any of those services provided to self-pay patients could become eligible for retroactive Medicaid. However, it’s a difficult task to continuously monitor a patient’s eligibility status. Many services eligible for retroactive Medicaid coverage will expire beyond their timely-filing periods before they are identified.

According to Medicaid, timely filing periods are defined as 12 months, or 1 calendar year after the services were furnished.

Luckily, retroactive reimbursement monitoring can help overcome the challenge of monitoring eligibility status.

Retroactive Reimbursement Monitoring

Retroactive reimbursement systems monitor all encounters with self-pay patients and sliding fee patients. These systems monitor patient encounters for the full length of their timely filing periods.

If any of these encounters becomes eligible for retroactive reimbursement at any time within the timely filing period, the system alerts the medical practice, and provides all the information required for retroactive reimbursement.

Retrocaid: The Retroactive Medicaid Reimbursement Solution

The Retrocaid solution uses proprietary algorithms to check the eligibility status of every encounter with self-pay patients and sliding-fee patients within your system. The encounters are monitored daily for the full length of their timely-filing lifespans. From there they are further prioritized so that time sensitive claims are acted upon immediately.

With daily review, RetroCaid quickly catches newly eligible encounters and helps your practice meet timely filing deadlines. This results in the maximum possible retroactive medicaid reimbursements for your medical practice.

With RetroCaid, there are:

RetroCaid helps practices recover every retroactive reimbursement opportunity.

Get in touch to find out more about how RetroCaid can help you never miss another retroactive reimbursement again!