Federally Qualified Health Centers (FQHCs), Rural Health & Community Health Centers

Are challenged with loss of revenue due to poor tracking of Medicaid eligible patients and services already rendered to them prior to eligibility.  If you are part of any of the following organizations you could benefit from our contingency based service where we only charge if we help you recover your Medicaid allowed funds.

•  Federally Qualified Health Centers (FQHCs)
•  Rural Health Clinics (RHCs)
•  Community Health Centers
•  FQHC Look-Alikes
•  Behavioral Health Care Providers
•  Substance Abuse Treatment Centers

These providers all share one common mission. To provide care for patients regardless of their ability to pay or individual health insurance status.

These patients are typically recorded in the patient accounting system as Self-Pay and/or Sliding Fee encounters.

The Retroactive Medicaid Challenge

While a patient may not have had Medicaid coverage on their date of service, many times that same encounter can go on to become eligible for retroactive reimbursement through Medicaid long after the initial visit.

This presents a challenge for Community Health Providers since a busy practice can have thousands of self-pay and sliding fee encounters in their Patient Accounting System, with more being added every month. Any of those encounters can potentially become eligible for Retroactive Medicaid, but unfortunately many will expire beyond their respective timely filing periods before the provider discovers them.

What About The ACA?

Even with the millions of people who have gained coverage under the ACA and the great strides that have been made to facilitate the Medicaid enrollment process at the point of care, many patients begin their application process long after their initial visit. Regardless of where the application process begins, eligibility determination in most states can take 30-90 days, if not longer. When patients are slow to provide the necessary documentation, and additional time is required for those who appeal their denied applications, the final determination date can stretch well beyond six months.

You Might Be Thinking…

“Our Team Checks These Regularly“

Manually tracking thousands of historic self-pay encounters on a daily basis to determine retroactive Medicaid eligibility status is not only impossible, its impractical and cost prohibitive to even try.

With thousands of potential Self-Pay and Sliding Fee encounters within their systems, FQHCs lose hundreds of thousands of dollars in retro-Medicaid every single year simply because they’re unable to keep up.  Capturing retro-eligible encounters before they expire beyond their timely filing periods requires the ability to track every single Self-Pay and Sliding Fee encounter on a daily basis for the full length of each encounters respective timely filing period.

With millions of dollars in retroactive Medicaid at stake, and a limited period of time in which a healthcare provider can be retroactively reimbursed, it’s critical to have an effective and economical solution for tracking self-pay and sliding fee encounters daily to ensure every single retroactive reimbursable encounter is caught and collected.

“We Have Benefits Coordinators / Navigators“

Many Community Health Providers have begun using onsite Benefit Coordinators / Navigators to provide uninsured patients with Medicaid enrollment assistance. These Navigators have become an essential part of a Community Health Providers’s daily business routine. But once the patient leaves the facility, many are slow to provide the necessary documentation required to complete their applications, if at all.

This leaves Navigators with the impossible task of following-up and tracking hundreds, if not thousands, of pending and partially completed applications. Many of these patients will go on to be treated at other providers and some will eventually complete their applications at other facilities.

RetroCAID Tracking compliments the Navigator process by providing a tool for tracking every single Self-Pay encounter, whether a Medicaid application is pending, partially completed, or even where the application process wasn’t initiated by your team.

Whether your facility has 100 or 100,000 self pay encounters annually, each patient and their respective encounter is tracked daily for the full length of its timely filing period. No matter where the patients application process begins or where its completed, your facility will immediately be alerted the moment an encounter becomes eligible for Retroactive Medicaid reimbursement.  RetroCAID Tracking provides a safety net that Community Health Providers simply cannot afford to be without!