Medicaid Reimbursement Conversion
Imagine converting 5-10% of your Medicaid Reimbursement to commercial managed care payers. At most providers, government reimbursement is half of the payment received from a commercial payer. Below you will see why:
o TMP can convert 5-10% of your Medicaid Reimbursement to other payers1
o How this 5-10%, will effectively double the payment for those claims
o How this can mean $millions to Net Income
For Example:
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Medicaid Conversion to Commercial Payer Benefit Calculation
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This hospital's most recent cost reporting period is for the period ending 12/31/2006
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Sample 3 Hospital System
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Medicaid Gross Revenue
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Hospital A
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$23,445,787
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Hospital B
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$25,632,893
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Hospital C
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$23,807,000
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TOTAL Governmental Programs
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$72,885,680
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Medicaid Conversion to Commercial Payer
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5.0%
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(GAO report indicate up to 17% could convert)
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Net Improvement in Reimbursement per Claim
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100.0%
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(improve payment from 30% to 60% of charges)
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Net Medicaid ANNUAL Conversion Benefit
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$3,644,284
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In a recent Government Accountability Office report (GAO-06-862) issued in September, 2006 it concluded that about 13% of Medicaid claims are possibly covered by another payer. When secondary payers exist and are not found then revenue is not secured from the best source. This can result in lower Revenues. By checking all managed care payers for eligibility alternate payers or self pay patients can be identified more accurately, co-pays collected up front. As this study suggests, Medicaid does not know if the patient has alternative coverage, so just checking with Medicaid will not tell you that alternative coverage exists.
By creating a Direct Connection network with your commercial managed care payers, TMP has the ability to automate many functions and transactions that have significant impact on ROI and huge impact on cash flow from operations. This technology-enabled service will allow hospitals to:
· Check all managed care payers for eligibility via 270/271 transactions
· Identify multiple insurance payer coverage and respond accordingly