WINCHESTER, VA – Hospitals dealing with patients who say they have no insurance often have trouble collecting for services after the fact. Even though some organizations may feel that payment is a long shot at best, Valley Health has found that it’s worth it to consistently run those patients by state Medicaid programs.
The Winchester, Va.-based network of hospitals and treatment centers, which handles about 500,000 patient visits, recently found $3 million in charges from 2006 that it could bill to Medicaid programs.
Of that amount, the system received $1.6 million, a return that far exceeds the cost Valley Health paid to the vendor that handles the batch data submissions.
“Money has been left on the table,” said Bonnie Sarver, fiscal assistant in the patient accounts department, who noted the use of automation helps Valley Health avoid writing off some bills as bad debt.
The healthcare industry is complicated for some people, who may not fully understand their health benefits when they qualify for Medicaid.
“For a lot of these people who are on Medicaid and welfare, the perception is that it’s not insurance,” Sarver said.
“We have eligibility workers that interview self-pay patients to determine if they qualify for Medicaid because, without help, they often did not understand the applications and therefore didn’t qualify for any type of assistance or charity,” she noted. “For example, in Virginia, we can do a Medicaid application without a personal interview, so this helps us pick up patients who would not follow through.”
Valley Health, a longtime customer of The SSI Group, uses the Mobile, Ala.-based company’s Eligibility Clearinghouse services to submit the claims to Medicaid. The provider sends SSI a spreadsheet file once a month containing self-pay claims. SSI extracts data, including demographic information needed to make a match with Medicaid information, and submits it to the agency. After it gets a response, it responds to Valley Health with any matches.
Sarver said the provider has seen gradual increases in the amount of billable charges that it discovers through this process since it began using it in 2002 and identified about $1 million in charges. It now sends about 7,500 to 8,500 claims every month to SSI for review.