A health insurance claim form along with the blog title – Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

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EligibilityAdvocates Blog

Out-of-State Medicaid Reimbursement:

Top Challenges & Solutions

Posted on Friday, February 5, 2021

Out-of-state Medicaid reimbursement poses significant challenges to healthcare facilities. Many choose to write off these difficult claims. Those that attempt to work them experience success rates so low, they don’t seem worth the effort.

Fortunately, you don’t have to lose out on this valuable revenue.

Below are the top challenges to out-of-state Medicaid reimbursement along with the ways in which EligibilityAdvocates can help you solve them.

Challenge: Changing Regulations


A health insurance claim form along with the blog title – Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

EligibilityAdvocates has expertise in each Medicaid program and can help solve your challenges to out-of-state Medicaid reimbursement.

It is very hard for an internal billing team to keep track of all the rules governing Medicaid because they are continually modified and vary from state to state. Each state, U.S. territory, and Washington, D.C. has a separate Medicaid program with its own requirements and processes. If you do manage to find an employee with this niche expertise, an additional challenge arises in retaining the employee or retraining someone else if you face turnover.

Solution: EligibilityAdvocates provides a team of experts who specialize in out-of-state Medicaid and every unique Medicaid program while staying up-to-date on all new laws and policies.

Challenge: Enrollment of Facility AND Providers


Before you can submit a claim to Medicaid, you must enroll your facility and providers in the specific state’s program you are billing. This is a very involved task as it typically requires gathering sensitive personal information (e.g. social security numbers, home addresses, copies of driver’s licenses, signatures) from each of the hospital’s board members and/or physicians. Even ordering, prescribing, and referring (OPR) providers for Medicaid patients must complete OPR provider enrollment.

Enrollment must be completed in a timely manner so that you don’t miss your window for reimbursement. The enrollment process and which documentation each program requires for enrollment differs by state, further adding to the difficulties. In fact, may healthcare organizations consider this the most painful step on the road to out-of-state Medicaid reimbursement.

Solution: EligibilityAdvocates completes, submits, and maintains your facility AND provider enrollment applications at no additional cost to you. Save yourself the money, time, and headache it takes to accomplish this job and simply let us do it for you.

Challenge: Billing & Follow-Up


The billing process for Medicaid also differs by state. Each program has its own claim forms, billing requirements, list of covered services, and reimbursement rates. Even a simple error like using the Medicaid billing template for your own state to submit a claim to another state’s program can result in a denied claim.

Your billing team will need to devote time to follow up on delayed or denied claims, sometimes unaware of why the claim was initially rejected.

Solution: The EligibilityAdvocates out-of-state Medicaid team has experience in all 50 states’ billing procedures. We will bill and follow up on each out-of-state Medicaid claim for you, ensuring no claim is neglected, as well as take care of the appeals process for any denied claims when necessary. Not only are our team members specialists in claims resolution for Medicaid and out-of-state Medicaid, but our Medicaid expertise and pre-arrival workflow solution also prevent errors and issues that cause denials, underpayments, and reimbursement delays in the first place – providing you with higher remittance and quicker reimbursement.

Challenge: Maintaining Qualifications & Revalidation


For each Medicaid program you wish to bill, your facility must maintain its qualifications according to the program’s requirements and your providers must complete periodic revalidation with the program(s). Failure to do so will result in deactivation with the Medicaid program and denied claims. If a provider is un-enrolled, re-enrollment will entail more time and work and there may be a gap in eligibility for reimbursement.

Solution: EligibilityAdvocates provides maintenance and monitoring of all your Medicaid credentials to prevent expirations and deactivation and to make sure you are proactively maintaining compliance with each program.

Challenge: Drain on Resources


Each of these challenges requires time, expertise, and resources that your staff may not have or that they cannot afford to take away from their other billing responsibilities. Focusing their attention on out-of-state Medicaid reimbursement is not the best use of their time and your money if they do not collect a sufficient volume of revenue.

Solution: EligibilityAdvocates is a performance-based extension of your revenue cycle team. Our services are strictly contingent, meaning we don’t get paid until we’ve delivered on our promise to get you paid. The revenue we bring in will always exceed the cost of our services and your employees can focus on other objectives while we manage your complicated out-of-state Medicaid work.

Solve Your Out-of-State Medicaid Reimbursement Challenges with EligibilityAdvocates


Outsource out-of-state Medicaid work to EligibilityAdvocates and we will take on these challenges for you. No longer will you need to assign time, energy, stress, and staff to these complex claims or write them off as bad debt.

We will handle all aspects of out-of-state Medicaid enrollment, billing, and follow-up for you, so you don’t miss out on this substantial source of revenue. Contact us today and start collecting the out-of-state Medicaid reimbursement you are due!


By Stephanie Salmich

Lengthy checklists representing the time-consuming process of provider screening are shown along with the question: How do CMS provider screening requirements affect out-of-state Medicaid claims?

CMS Provider Screening Requirements & Out-of-State Medicaid Claims

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EligibilityAdvocates Blog

CMS Provider Screening Requirements & Out-of-State Medicaid Claims

Posted on January 21, 2021

Lengthy checklists representing the time-consuming process of provider screening are shown along with the question: How do CMS provider screening requirements affect out-of-state Medicaid claims?

EligibilityAdvocates specializes in all regulations that affect out-of-state Medicaid reimbursement, including CMS provider screening requirements and state-specific procedures.

The New Year is here and it’s time for families to start traveling. With travel, come patients from out-of-state. With out-of-state patients, come out-of-state Medicaid claims.

All states have their own rules and regulations regarding Medicaid. But on March 25, 2011 the Centers for Medicare & Medicaid Services (CMS) implemented additional screening requirements for states to follow for Medicaid provider enrollment. If these requirements are not met, the provider risks termination from the Medicaid program and/or a delay in reimbursements.

How Do CMS Provider Screening Requirements Affect Out-of-State Medicaid Claims?

Here are the top 6 requirements, which can be found in the Federal Register, that affect the out-of-state Medicaid enrollment and billing process:

1.) Database Checks

Requirement: States are required to screen all providers “upon initial enrollment and monthly thereafter for as long as the provider is enrolled in the Medicaid program” (p. 5897).


2.) Unscheduled & Unannounced Site Visits

Requirement: The Secretary may carry out unscheduled and unannounced site visits. “States must conduct pre-enrollment and post-enrollment site visits for those categories of providers the State designates as being in the “moderate” or “high” level of screening.” Providers must permit the on-site visits (p. 5898-5899).


3.) Provider Enrollment & Provider Termination

Requirement: All providers must undergo screening at least once every 5 years. States are required to deny or terminate the enrollment of providers if:

  1. The provider “does not submit timely and accurate disclosure information or fails to cooperate with all required screening.”
  2. The provider is “terminated on or after January 1, 2011 by Medicare or any other Medicaid program or CHIP.”
  3. The “provider fails to submit sets of fingerprints within 30 days of a State agency or CMS request.”

States can also deny enrollment to a provider “if the provider has falsified any information on an application or if CMS or the State cannot verify the identity of the applicant” (p. 5900).


4.) Criminal Background Checks & Fingerprinting

Requirement: Each provider the State designates as within the “high” level of screening is subject to fingerprinting (p. 5901).


5.) Deactivation & Reactivation of Provider Enrollment

Requirement: Medicaid providers who have “not submitted any claims or made a referral that resulted in a Medicaid claim for a period of 12 consecutive months” must have their Medicaid provider enrollment deactivated (p. 5903).


6.) Enrollment & NPI of Ordering or Referring Providers

Requirement: The State “must require all ordering or referring physicians or other professionals to be enrolled under a Medicaid State plan or waiver of the plan as a participating provider.” Their NPI must be on applications to enroll and on all claims for payment (p. 5903).


The CMS regulations established more consistency in the screening process so that states can better ensure providers are qualified to serve the Medicaid population. However, since the CMS provider screening requirements were enacted, many providers have been discouraged to seek out-of-state Medicaid reimbursement because of the amount of work involved in the application process. Plus, on top of these standardized enrollment requirements, states vary in their rules and regulations for filing claims.

Don’t Miss Out on Out-of-State Medicaid Revenue


At EligibilityAdvocates, we are experts in out-of-state Medicaid. From CMS provider screening requirements to each state’s individual Medicaid program (and temporary waivers related to COVID-19), we keep track of all rules and regulations that affect out-of-state Medicaid reimbursement.

When you outsource out-of-state Medicaid work to EligibilityAdvocates, you can collect payment for these complex claims without devoting your time and resources to monitoring (ever-changing) federal and state regulations. We will do so for you and take care of every aspect of Medicaid enrollment for both the provider and facility, claims submission, and claims follow-up.

Contact us today to learn more about how we can help your practitioners and facility meet CMS provider screening requirements and obtain reimbursement for your out-of-state Medicaid claims – all at a performance-based rate.


By EligibilityAdvocates

A doctor completes a form on a tablet below the caption - FREQUENTLY ASKED QUESTIONS: OPR Provider Enrollment

Ordering, Prescribing, and Referring (OPR) Provider Enrollment FAQs

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EligibilityAdvocates Blog

Ordering, Prescribing, and Referring (OPR) Provider Enrollment FAQs

Posted on January 21, 2021

Even if you do not submit claims to Medicaid, you are required to complete OPR provider enrollment if you are an ordering, prescribing, and referring (OPR) provider for Medicaid patients. This requirement was implemented by the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS).

To help you navigate this process, we’ve compiled a list of the most common questions we receive from ordering, prescribing, and referring providers regarding Medicaid enrollment.

A doctor completes a form on a tablet below the caption - FREQUENTLY ASKED QUESTIONS: OPR Provider Enrollment

EligibilityAdvocates can answer your OPR provider enrollment questions and manage the Medicaid enrollment process for you.

OPR Provider Enrollment FAQs


1) Why are OPR providers required to complete Medicaid enrollment?

Additional integrity requirements are placed on state Medicaid programs. This requirement complies with federal regulation 42 CFR 455.410 concerning the screening and enrollment of providers.


2) How do I know if I should enroll as an OPR provider?

This type of enrollment may be suitable for you if:

  • You occasionally see Medicaid recipients who need additional services/supplies that can be covered by Medicaid.
  • You do not plan to submit claims to Medicaid for reimbursement.
  • You are not enrolled as another Medicaid provider type.

3) What are the OPR requirements?

The 3 basic OPR requirements are:

  1. The provider who wrote the order/prescription/referral must be enrolled in Medicaid (either as a participating Medicaid provider or as an OPR provider) and that provider’s NPI must be included on the claim.
  2. The provider’s NPI must be for an individual physician or non-physician practitioner (not an organizational NPI).
  3. The provider must be of a specialty type that is eligible to order, prescribe, or refer.

4) Do I have to be enrolled as a participating provider or can I be enrolled only as an OPR provider?

If you will only be ordering, prescribing, and referring services for Medicaid recipients and won’t be billing Medicaid for these services, you may enroll as only an OPR provider. But if you wish to bill Medicaid, you must enroll as a fully participating Medicaid provider.

OPR providers do not bill Medicaid and are not required to treat Medicaid patients.


5) If I am already enrolled as an active provider with a state’s Medicaid program, do I also need to enroll as an OPR provider in that state?

No; anyone who is an active Medicaid participating provider does not need to enroll again as an OPR provider.


6) Is there a separate Medicaid enrollment application for OPR providers?

Yes; each state has a separate Medicaid enrollment application specifically for OPR provider enrollment.


7) If I am enrolled in one state’s Medicaid program, do I still need to enroll in other states’ programs?

If you order, prescribe, refer, or render services for a Medicaid patient, you must be enrolled in the state program to which the patient belongs. For example, if you are a provider located in California and enrolled in California’s Medicaid program and you write a prescription for an Arizona Medicaid recipient, you must be enrolled in the Arizona Medicaid program as well.


8) What will happen if I fail to complete Medicaid enrollment as an OPR provider?

The healthcare providers and facilities who deliver services according to your orders/prescriptions/referrals will not be reimbursed by Medicaid for those services if you are not enrolled and your NPI is not included on the Medicaid claims they submit.


9) If a claim is denied because the OPR provider is not enrolled in the Medicaid program, can the OPR provider retroactively enroll?

In most cases the billing provider can resubmit the claim after the OPR provider enrolls. There are state-specific claim timely filing limitations.


10) Do claims submitted to Managed Care Organizations (MCOs) have to follow the OPR requirements?

This depends on each MCO or HMO and its specific requirements.

OPR Provider Enrollment Services


EligibilityAdvocates handles all aspects of Medicaid enrollment for both OPR providers and fully participating Medicaid providers, including out-of-state Medicaid enrollment.

If you have more questions regarding OPR provider enrollment or would like EligibilityAdvocates to take care of this process for you, please contact us here.


By EligibilityAdvocates

A map of the United States illustrates the 50+ Medicaid programs that we will monitor for you when you outsource out-of-state Medicaid work to EligibilityAdvocates.

Why Outsource Out-of-State Medicaid Billing? 

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EligibilityAdvocates Blog

Why Outsource Out-of-State Medicaid Billing?

Posted on January 8, 2021

If you’re struggling with out-of-state Medicaid enrollment and/or billing in-house, it may be time to consider an alternative solution. Outsource out-of-state Medicaid enrollment and billing to a performance-based company that specializes in these claims.

Here are the top reasons to outsource out-of-state Medicaid enrollment and billing:


1. Lack of internal resources.

Like many healthcare organizations, you may choose to write off out-of-state Medicaid accounts rather than allotting time and resources to working these complex claims. However, you are missing out on a substantial form of reimbursement that could improve your revenue cycle while reducing aged receivables.

2. Lack of expertise in complicated out-of-state Medicaid claims requirements.

If you have tried to manage these difficult claims internally, you’ve probably found that they require more time and expertise than your staff can reasonably deliver. EligibilityAdvocates specializes in out-of-state Medicaid and we handle all the work necessary for reimbursement. This includes enrolling providers and facilities in states’ Medicaid programs, billing and submitting claims, following up on any delayed claims, and appealing denials. We devote our time and extensive resources to all aspects of the out-of-state Medicaid process so your teams can focus on other objectives.

3. No standardization – there are over 50 Medicaid programs.

A map of the United States illustrates the 50+ Medicaid programs that we will monitor for you when you outsource out-of-state Medicaid work to EligibilityAdvocates.

EligibilityAdvocates is knowledgeable in all 50+ Medicaid programs.

Each state, U.S. territory, and Washington, D.C. has its own Medicaid program with different and continually changing rules. Additionally, there are new and temporary Medicaid flexibilities to navigate due to COVID-19 and these vary by state as well. When you choose a partner who is proficient in every Medicaid program, you don’t have to keep track of all these moving parts – we do it for you.

4. Occurrence is increasing, Medicaid Expansion, and Americans love to travel.

Even in light of COVID-19, a recent survey of over 30,000 Americans found that 46% are ready to travel once lockdowns are lifted. Expansion and the increase of Medicaid patients accessing care outside their enrollment states will continue to grow for hospitals in the future.

5. Return on investment – move to performance-based contingent fee pricing.

It’s difficult to realize a positive ROI when a facility manages, enrolls, and/or bills out-of-state accounts. Switch to a performance-based resource. There are no up-front costs OR facility enrollment fees when you outsource out-of-state Medicaid work to EligibilityAdvocates. You only pay for our services once we’ve delivered results and the hospital has received payment.

6. Improve A/R and see an increased remittance.

Our out-of-state Medicaid specialists have the knowledge, experience, and technology to provide you with quicker reimbursement, at a higher rate. EligibilityAdvocates combines out-of-state Medicaid experts with workflow automation technology to streamline claims resolution management.

7. Look to EligibilityAdvocates to expand your revenue cycle team with no increase in internal labor costs.

EligibilityAdvocates is a performance-based partner that serves as an extension to your revenue cycle team. By partnering with us, you can ensure your out-of-state Medicaid accounts are settled without the need to hire additional staff to work them. You won’t have to train new employees, add them to your payroll or benefits programs, or pay for any extra office space and equipment (desks, computers, phones, etc.). These are fixed expenses, regardless of how much money your staff actually collects. Conversely, when you hire EligibilityAdvocates you’ll only pay us as much as our performance warrants.

Outsource Out-of-State Medicaid Billing


You may not have the time and resources needed to work out-of-state Medicaid claims, but you can’t afford to lose out on this valuable source of revenue either. The simple solution is to outsource out-of-state Medicaid work to an external billing company like EligibilityAdvocates.

Protect your revenue without the hassle – outsource out-of-state Medicaid billing to EligibilityAdvocates today.


By EligibilityAdvocates

A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

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EligibilityAdvocates Blog

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

Helping Uninsured Americans Access COVID-19 Testing and/or Treatment

Posted on Monday, August 17, 2020

Updated Friday, August 28, 2020: The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020.

Providers still have time to apply for aid through the CARES Act Provider Relief Fund. Below you’ll find important information about this program that can help providers recover revenue lost to the COVID-19 crisis and help uninsured patients avoid unexpected medical bills related to coronavirus testing and treatment.

Information for Providers


The federal government has allocated $175 billion to the Provider Relief Fund (PRF) to be distributed to qualified health care service and support providers for:

  • Appropriate expenses
  • Lost revenue due to COVID-19
  • Helping uninsured Americans access COVID-19 testing and/or treatment

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion, and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) appropriated $75 billion, to this program. The program is administered by UnitedHealth Group through a contract with the Health Resources & Services Administration (HRSA).

Payments from the Provider Relief Fund do not need to be repaid by providers who comply with the program’s terms and conditions.

Information for Uninsured Patients


According to HHS.gov: “Providers who participate in and are reimbursed from the HRSA COVID-19 Uninsured Program are not allowed to “balance bill” individuals who do not have health care coverage (uninsured).”

If you are an uninsured patient and you receive a bill for COVID-19 testing and/or treatment services which shows that a portion of the bill was paid for by the Health Resources & Services Administration (HRSA), you should contact your healthcare provider as you may not be responsible for the balance.

However, if your provider did not participate in the HRSA COVID-19 Uninsured Program or the care you received was not eligible for reimbursement from the program’s funds, you may be responsible for payment.

Applying for Reimbursement Through the CARES Act Provider Relief Fund


 

 

A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

UPDATE: PROVIDERS – The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020 to apply for Phase 2 General Distribution funding from the CARES Act Provider Relief Fund.

The deadline to apply for Phase 2 General Distribution funding has been extended to September 13, 2020. Providers should check the HHS.gov website for the latest updates on deadlines and requirements.

Key conditions for reimbursement from the Provider Relief Fund include:
  • Screening patients for health coverage to ensure they are uninsured.
  • Accepting the payment provided from the fund and refraining from further billing the patient.
  • Submitting to a post-payment audit.
  • Confirming that COVID-19 is the primary diagnosis (except in the case of pregnancy).
Additional points to keep in mind:
  • Reimbursement is generally at Medicare rates and payment is dependent upon available funding.
  • Qualifying health costs and services such as COVID-19 testing, office visits, telehealth, non-emergency transportation, and more, with dates of service/admittance on or after February 4, 2020, are eligible for reimbursement.
  • Claims cannot be repealed or reprocessed after submission.
  • To submit claims electronically, providers need a clearinghouse or similar relationship.
  • Providers must attest that the information submitted is correct (billing companies/revenue cycle vendors can attest to the accuracy of the information for the provider).

EligibilityAdvocates can help providers apply for reimbursement from the CARES Act Provider Relief Fund, navigate regulatory flexibilities related to COVID-19, and screen patients for insurance coverage.

Contact us for more information on the CARES Act Provider Relief Fund or to get started on the application process before the deadline.


By EligibilityAdvocates

A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Why Outsource Patient Eligibility Services?

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EligibilityAdvocates Blog

Why Outsource Patient Eligibility Services?

Posted on Thursday, July 30, 2020

An on-site patient eligibility service can significantly improve patient experiences, increase self-pay conversions, and reduce account cycle time. For the best results, patient eligibility services should be performance-based and you should choose a vendor who can provide both on-site patient advocates and cutting-edge technology.

Here are just a few reasons to outsource patient eligibility services:


A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Outsource patient eligibility to maximize
patient advocacy and reimbursement.

Establish a Culture of Patient Advocacy

Show your patients and everyone who belongs to your organization that your facility values and is committed to patient advocacy. The presence of a patient eligibility and enrollment service, on site and at no cost to patients, will do just that.

This service supports patients by:

  • Finding insurance coverage and/or enrolling them in health plans.
  • Identifying financial assistance opportunities and handling the application process for them.
  • Reducing their medical expenses.
  • Helping them navigate the financial aspects of their healthcare through financial counseling and education.
  • Alleviating patient financial stress and confusion.
  • Increasing patient engagement with one-on-one, in-person interaction.
  • And more.

However, the help that an internal eligibility team can provide is often inhibited by their limited hours. Most facilities’ eligibility employees work a typical 9:00 AM to 5:00 PM schedule, whereas EligibilityAdvocates’ outsourced services are available on site, including in the Emergency Department, at a minimum of 12 hours a day and 6 days a week (and up to 24 hours/day, 7 days/week – based on peak analysis). This significantly extends patients’ access to support.

The more support you offer your patients, the bigger impact you can make on your entire community’s economic outlook. Our patient eligibility services help patients and healthcare facilities financially; plus, we create job opportunities because we hire patient advocates from your local community to fill all our on-site positions.

Maximize Patient Advocacy & Reimbursement with a Team of Experts

When you outsource patient eligibility and enrollment, you can ensure your patients are served by patient advocates who specialize in this service and all the rules and regulations that impact it.

State and federal laws, as well as individual health plan and financial assistance program requirements, change regularly. And waivers are often enacted when national emergencies like the COVID-19 crisis occur.

EligibilityAdvocates monitors all policies and guidelines that determine whether a patient will qualify for assistance, what the patient must do to apply, and how your reimbursement will be affected. You and your patients don’t have to keep track of all these moving parts or risk missing a detail that results in a denied application or claim.

Our expertise also covers out-of-state Medicaid, denial prevention, and follow-up on unpaid/underpaid claims.

Utilize the Vendor’s Technology

In addition to patient advocates’ extensive knowledge and compassion, an outsourced patient eligibility service can bring innovative technology to the table as well.

At EligibilityAdvocates, we equip our patient advocates with technology that enables mobile patient screening, such as at bedside or in the field. This includes convertible laptops/tablets, HL7 for real-time notes, electronic forms automation software, data encryption in transit and at rest, intermediate saves of information, and photo capture for documentation of driver’s licenses, insurance cards, etc.

We also supply our clients with customized dashboards and reports that deliver near-real-time transparency and alerts. Plus, our pre-arrival workflow solution streamlines financial clearance and automates many tasks for Patient Access.

All our solutions are HIPAA-compliant and will adhere to your organization’s specific procedures and compliance standards.

Reduce Uncompensated Care and Improve Your Revenue Cycle

Partnering with a patient eligibility and enrollment service provider will reduce your write-offs and A/R days. When patients obtain health coverage and/or financial assistance, you get reimbursed at higher rates. And, the face-to-face meetings between patients and patient advocates result in higher conversion rates, increased point-of-service payments, and the establishment of patient payment plans.

When you choose EligibilityAdvocates, we will pursue every possible source of funding for each patient account – so your organization will always be the “payer of last resort.”

You’ll also improve your revenue cycle with the benefits of our pre-arrival workflow solution, which prevents integrity issues and errors that would otherwise cause payment delays, denials, underpayments, and rework.

Experience a Greater Return on Investment

Your ROI will be much higher when you outsource patient eligibility services in comparison to managing this work internally.

Costs accrued by in-house staff include payroll and benefits, hiring and (ongoing) training expenses, office space, and equipment (phones, computers, printers, desks, etc.). You’ll need to allocate money, time, and resources to these employees whether their performance earns it or not.

In contrast, EligibilityAdvocates offers contingent fee pricing, so you’ll only pay us a percentage of the reimbursement we collect, and you won’t have to worry about any of the typical labor costs an internal team would necessitate.

Keep Your Focus on Patient Care: Outsource Patient Eligibility Services


EligibilityAdvocates can handle all aspects of patient eligibility and enrollment for you so that your teams can devote their time and resources to providing quality patient care.

Contact us to learn more about how we can lower or eliminate your patients’ out-of-pocket costs and improve your revenue cycle.

Strengthen the financial situation of all stakeholders in your organization – outsource patient eligibility services to EligibilityAdvocates today.


By EligibilityAdvocates

EligibilityAdvocates COVID-19 Response - Thank You, ALL Healthcare HEROES!

EligibilityAdvocates COVID-19 Response

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EligibilityAdvocates

COVID-19 Response


The coronavirus (COVID-19) is affecting all individuals and organizations in significant ways – physically, emotionally, and financially, to name a few. In addition to creating a national health emergency, more people are out of work and without insurance as a result of this crisis.

EligibilityAdvocates COVID-19 Response - Thank You, ALL Healthcare HEROES!

THANK YOU, from all of us at EligibilityAdvocates!

Thankfully, our patient advocates can continue serving patients during this difficult time. They have been classified as essential staff members and are working on-site to help patients obtain benefits and secure alternative payment methods (including COBRA).

We at EligibilityAdvocates would like to thank all those working in health care who are risking their own safety in order to protect and care for these patients and keep our communities healthy. You are truly health care heroes.

We also want to express appreciation for each one of our patient advocates who is making a critical difference in patients’ lives on the front lines as well.

You are health care heroes too, as you work to minimize the financial impact of this virus on individuals and families.

CMS Waivers


As you may be aware, the Centers for Medicaid and Medicare Services (CMS) issued emergency blanket waivers in response to COVID-19, which have a retroactive effective date of March 1, 2020 until the end of the emergency declaration.

We’d like to draw your attention to these changes in particular, as stated by CMS:

  • 3-Day Prior Hospitalization Waiver for SNF placement – “CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).”
  • CAH Length of Stay Waiver – “CMS is waiving the requirements that CAHs limit the number of beds to 25, and that the length of stay be limited to 96 hours under the Medicare conditions of participation for number of beds and length of stay at 42 CFR §485.620.”

States and territories may submit a request for a waiver of statutes and regulations related to Medicaid and CHIP programs using the 1135 waiver checklist; CMS provides these examples of flexibilities they may seek:

  • “Waive prior authorization requirements in fee-for-service programs.
  • Permits providers located out of state/territory to provide care to another state’s Medicaid enrollee impacted by the emergency.
  • Temporarily suspend certain provider enrollment and revalidation requirements to increase access to care.
  • Temporarily waive requirements that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have an equivalent licensing in another state; and,
  • Temporarily suspend requirements for certain pre-admission and annual screenings for nursing home residents”
Please see the complete COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers document or contact us for more information.

As always, we are here to help you navigate these new regulatory flexibilities and to assist your patients with the financial challenges they may be facing. We are all in this together as we work to protect the physical and financial health of your patients and their families.