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Encompass Collects an Extra $130k for Client after Medicaid Rule Change

Encompass Healthcare Data Solutions went above and beyond to collect approximately $130,000 on 9,000 claims for one of its clients after a recent Colorado Medicaid regulatory change. In May, 2018 the Colorado Department of Health Care Policy and Financing announced an update made to the rounding methodology utilized for anesthesia units and providers. The new regulation requires claims to be submitted in 15-minute increments. For example, an anesthesia procedure lasting 12-minutes would need to be billed as 15-minutes.

In order for claims to be adjusted to be accurately reimbursed, claims with dates of service prior to May 31, 2018 needed to be resubmitted to reflect the new rounding requirements. For one of its clients, initial estimates by the Encompass Revenue Cycle Management (RCM) Insurance Receivables team identified approximately 9,000 qualifying claims totaling $130k in additional revenue. Resubmission, rather than re-keying, was necessary to meet the new requirements.

Significant staff time was invested to re-coup the additional claim money for its client – 840 total hours, with each RCM Insurance Receivables team member devoting 20 hours per work week until the project was complete. The Encompass management team also faced a budgetary dilemma. If all $130k was collected for the client the RCM share of that was approximately $8,500. However, staff cost to resubmit the claims exceeded $15,000. In the end, the obligation remained with the client and Encompass readily made the decision to resubmit the claims knowing that the RCM team would actually take a loss on doing so.

The project was completed in 6 weeks – both ahead of schedule and, therefore, nearly at breakeven for the department. The complex revenue cycle management process commands a lot of attention – attention that would be better spent on your patients. Our team stays on top of coding compliance rules and evolving state and federal requirements to make sure its clients have peace of mind that every dollar earned makes its way back to your practice.

Take a Revenue Cycle Management Risk Assessment today Revenue Cycle Risk Calculator


Encompass is a medical management company serving the healthcare industry by providing customized services in IT, revenue cycle management, clinical quality management, credentialing, payer contract and payer enrollment, and human resources.

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Source: PRWeb
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