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Provider Enrollment Critical for Out-of-State Medicaid Revenue

By Olivia Currin-Britt

Millions of dollars are written off every year because health care organizations avoid provider enrollment in Out-of-State Medicaid due to its complexity. The process of seeking Medicaid payment is onerous and intricate, especially since every state has different rules and documentation requirements to follow. Wyoming requires a 22-page packet to be completed; Georgia requires physicians to provide a résumé outlining their education, along with other personal information; Texas requires three applications to be completed if an individual has an attending physician, operating physician, and the hospital itself must be enrolled—adding up to a total of 264 pages worth of information.

Why Is It Important?
The number of employed physicians/hospitalists that must be enrolled for a claim to be paid is growing. If there is a delay in the enrollment process, it results in a delay in reimbursement, or in some cases no reimbursement at all. This can be traumatizing to the organization because every dollar is important, due to the rise of uncompensated care and the decline of federal Medicaid payments. More revenue must come into the organization vs being paid out.

Implementing an Out-of-State Medicaid program that supports provider and patient enrollment, credentialing, billing, and follow-up would ease up on tedious documentation requirements and help to regain lost claims. While the reimbursement and cash flow increase, bad debt and uncompensated care are reduced. Through the commitment of this type of program, providers can consistently drive bottom-line results while remaining patient centered.
Where should a provider start?

Ask the Questions
When beginning the provider enrollment process, it is important that revenue cycle leadership ask the following key questions of their organization:

• What is currently being recovered on Out-of-State Medicaid claims?
• Is the provider enrollment process efficient, and are applications being turned around in a timely manner?
• Can the organization integrate provider enrollment with credentialing to be more efficient and achieve timelier reimbursement?

Not only should providers gain a better understanding of their organization’s provider enrollment process, but they would be wise to get ahead of it by making themselves aware of certain challenges they may come across and how to resolve them.

Challenges
It is a burdensome and challenging administrative task to enroll with Medicaid. Enrollment applications include multiple forms for the hospital, ordering physician, and attending physician. Many times, these are paper documents, making the process to complete that much more time consuming. Personal and sensitive information (home address, social security number, and more) is needed from physician and board members, which often is difficult to obtain, especially when working within a paper application. Given that the requirements vary from state to state, there is no master resource that applies to the entire country.

Following the tedious application process, providers must be prepared to play the waiting game. Enrollment approval can take from 30 days to a year. During this time, accounts receivable continues to age and reimbursement dollars are written off. As a result, revenue cycle leadership must devise a plan to combat these challenges.

Solutions
Enrolling physicians requires a great partnership between the hospital, vendor, and/or internal team assigned to complete the enrollment. With this collaboration, revenue cycle leadership can adopt the following solutions for a successful enrollment:

• Know each state’s requirements and track. Create a tracker for each state showing the documents needed for physician and hospital enrollment along with timely filing guidelines, claim addresses, and phone numbers.
• Submit complete, current, and accurate information. Pay attention to the details—many applications have specific requirements. For example, some require signatures to be in blue or black ink.
• Start the process sooner rather than later. Figure out where in the process providers are collecting the physician enrollment information that will be required for Out-of-State Medicaid. Ensure that this information is collected when they are credentialing for other payers.
• Use online capabilities if available. Electronic forms and signatures provide some relief to the enrollment process. For example, Michigan, Illinois, and Ohio have an online process and electronic signature capability.
• Communicate in a timely manner. Providers can’t overcommunicate in this space. Enrollment approval may be received by the physician vs the enrollment team, so it is important to have a plan in place to ensure information is shared.
• Develop/improve the relationship with the physician recruitment team. The partnership with this team is key to the enrollment process. With their help, outline documents and requirements needed for enrollment.
• Consider help outside the organization. Working with a vendor to outsource the entire process from enrollment to billing/follow-up/appeals can take the burden off the organization. A vendor understands the requirements of each state and is able to drive efficiencies and improve revenue.

Through the commitment of this type of program, providers can consistently drive bottom-line results while remaining patient centered. The health care system will be able to increase reimbursement and cash flow while reducing bad debt and uncompensated care. In return, patients will have greater access to providers, better coverage for hospital services and follow-up care, and fewer out-of-pocket expenses; they will experience an overall positive visit.

— Olivia Currin-Britt is director of national sales strategy: patient responsibility at nThrive.