Today the most optimistic outlook is a reduction in that loss to only $53 billion for 2021. At least one report indicates that among the top causes is a marked drop in elective procedures:

• Cardiac procedures down 50 percent
• Cardiac elective surgeries down 65 percent

Learn strategies on how to mitigate and manage the impact of those losses here.

Communicate With Payers

With a decrease in elective procedures and an increase in losses as a result of Covid, maintaining relationships with payers has never been more important. Hospital management needs to ensure the lines of communications between key stakeholders and payers stay open and consistent. This can be streamlined:

• Discuss challenges with payers in real-time
• Implement a clear contract management system with relaxed negotiations
• Track administrative problems and offer transparent solutions to payers
• Monitor flow of all communication
• Utilize variance reports internally when non-payment from the payer occurs

It may be that you still aren’t recovering reimbursement losses even with the most efficient communication system internally and externally. You may just not know exactly where the losses are.

Track Your Payers

Your organization may benefit from tracking payers.  You can do this by comparing which payers are the most efficient for your hospital. Volume metrics are important here. So are metrics pertaining to the accuracy of reimbursements. You may be experiencing significant losses that just aren’t being caught.

Create a metrics system to analyze how payers contrast with each other. Where are you seeing the most denials?

Create reports that indicate areas of key losses. Tracking payers will enable you to identify where the most losses are occurring, even at the patient level.

Consider Value-Based Care

Depending on elective procedures as bread and butter revenue is a fee-for-service model. It is not the most secure model in health care now, because that revenue just isn’t there anymore. It has been cut by at least half to prioritize a greater health care need, and to prioritize quality care in a different area of health care. Transitioning to a value-based care system may be the clearest answer to the question, “what will health care look like after Covid?”

A value-based-care system considers reimbursement from a quality of care perspective. Here, accountability is key. The additional focus is on value-based care – good outcomes for patients. In this model, the hospital does not have to depend on how many hip replacements will be happening that month.

Instead, the performance metrics of the service providers themselves will be measured. When a physician can treat a patient in fewer visits than a fee-for-service model provides for, everybody wins.

In this scenario, health care administrators can effectively examine where costs need to be cut, without compromising level of service. In theory, it works. In practice, it works as well when administrators focus on contracts with payers that are operationally prepared for this model.

Health care organizations today do not find this to be the most lucrative model, and may be resistant to it. Some actually do want to profit from every Band-Aid. However, in this era, that mindset may need to be temporarily archived when board agendas contain keywords such as “hospital bankruptcy protection.”

Inflation is rising. Demand on hospital supplies and labor resources is tapping out everybody. Before Covid, hospital gowns for example cost 22 cents. Today, $10 each.

Rethink Revenue and Reimbursement Losses

Hospitals face financial challenges of historic proportions with historic implications, with inflation on the rise. Health care managers now face the task of managing the impact of those losses as elective procedures hit the pause button. The fee-for-service model isn’t feasible, or even as readily available, at this time.

Today’s boards face the issues of fewer staff, more expensive supplies, and a cycle of reimbursement losses that seems never-ending. What will health care look like after Covid? Boards and reimbursement managers might have tougher times managing the impact of revenue losses.

A value-based-care system can solve many of these problems. So can rethinking communication strategies with payers, and tracking them and their metrics more effectively. Contact us for more information and guides on how to improve revenue models in your own healthcare system. Check out our free assessment pages to learn more about how you can help your own organization.

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Why is Technology Taking Over?

All health care workers today must be both clinically experienced and tech-savvy. With the ongoing challenges in recruitment and retention, it’s essential for doctors to develop the right balance between adequate workflow and technology. Otherwise, an imbalance can potentially lead to dissatisfaction. It’s not easy to achieve this noble goal, and it may actually mean additional training and support as everyone keeps up with the process.

Notably, X-ray, lab, and pharmacy systems are not interoperable, and physicians are under obligation to enter every information into the medical record to address administrative and billing requirements. All this data entry means doctors have very little time to connect with their patients and address their needs. Studies by the American Journal of Emergency Medicine have found that doctors spend only 28 percent of their time on patients and 48 percent on data entry.

How to Create an Appropriate Balance?

The entire idea of incorporating tech in health facilities is to improve patient care. Every patient walks into a health institution hoping to get the best form of treatment technology could offer. Unfortunately, doctors spend more time on computers than physically talking to their patients, which significantly impacts health and wellness outcomes.

On the positive side, patients feel that technology makes processes faster, smoother, and more efficient. They also feel that their records are safer in data systems than on traditional hard copy files. The quick access to medical records helps ensure that patients are not misdiagnosed or given the wrong treatment. While this is good news, doctors still need to spend quality time with their patients. Developing quality communication and building doctor-to-patient relationships creates trust, and patients feel appreciated and respected.

It’s clear that technology is here to stay, and it will significantly benefit the health industry. Medical professionals will still need to juggle data entry and find ample time for their patients. It all comes down to timing.  Doctors can allocate specific time for patient interaction and give time for data entry. Entering data later in the day may not be effective. Instead, they can use the first few minutes entering data such as the symptoms and use the last few minutes for communication.

How Health Professionals Can Provide Proper Patient Care

Communication is a very powerful tool when used appropriately. It can be delivered in facial expressions and other non-verbal cues to convey different messages. Doctors often sympathize with their patients but may not always show this when they’re busy typing and entering data. This kind of attention is quite essential for sensitive and vulnerable patients with severe illnesses or those dealing with emotional or physical losses. Therapeutic touch and effective communication create a sense of security, and it may increase a patient’s confidence when feeling isolated, fearful, and lonely in an unfamiliar environment. Doctors should learn to:

• Give their full attention to their patients
• Listen, smile, lean forwards, or even nod or shake their heads gently to show interest.
• Make eye contact to convey respect and understanding
• Touch or place a hand on a patients’ shoulder to show care
• Consider hearing and visual limitations when interacting with patients.

Has technology contributed to faster patient care? Absolutely. That means more time can be created for patient interaction through proper scheduling.  Both doctors and patients greatly benefit from the efficiencies in the systems, which are constantly improved to provide even better health care.

For instance, a doctor doesn’t need to move from their office or send a patient to the lab or pharmacy with a piece of paper because they can communicate virtually with any medical professional in that hospital from their computers. Technology has also made billing--one of the most complex and critical areas of a health care system–more effective and accurate.

Need Help?

At Midland Group, we care about what you care, and that’s why we go out of our way to help you with your insurance claims. Our dedicated team of professionals is trained to handle tools, documents, and rules to submit a proper insurance claim. Feel free to call and schedule an appointment with us.

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First, let’s talk about why claim denials occur. This can happen for a variety of reasons. Perhaps there is not enough information in the form to make a decision from the insurance company’s perspective. The information provided may not match the client’s previous information. Perhaps there was an address change or other demographic information has changed since they applied for the insurance. Whatever the case, get the paperwork right first. Then we’ll talk about the other reasons you might be denied and how to avoid denials.

How Do I Avoid Having My Claim Denied?

There are a number of reasons claims might be denied besides having the wrong forms or having information that is outdated or irrelevant.  It is important that you understand the reasons so that you can present your claim in such a way that the insurance companies know it is a valid claim.

5 Tips to Help Avoid Denials

Here are some tips to remember to avoid denials when you file patient insurance paperwork:

1. Verify eligibility. It is important that you check to make sure your patient qualifies for the insurance in the first place to avoid it being automatically thrown back to underwriting or tossed out as an unqualified claim. Make sure the patient is covered for the medical condition that you are applying for on their behalf and get any questions answered at the onset to avoid service and payout delays.

2. Be specific about the medical condition. Insurance operates on a very specific assumption: that you are covering the exact illness or medical condition and under the circumstances that are covered by the insurance. Be sure this is accurate before starting a claim.

3. Be prompt. There’s nothing worse than missing a deadline. This is especially critical with insurance claims. The insurance claims are so specific that, by law, if you are even 1 minute past the deadline,  you are not covered and the policy will be invalidated.

4. Learn from former denials. If your claim was denied in the past, find out why it was initially denied and learn from that. Call the insurance company or do your own side research to determine the reason, then make notes so that you will not make this mistake in the future.

5. Talk to experts. When you are unsure of how to answer a company form for an insurance or billing claim, ask an expert with more experience so that you will get it right. You simply don’t have time to waste when your client is needing help with an insurance claim. Do your homework and visit with an insurance or medical billing specialist.

Where We Come In

When talking about insurance claim experts, that’s where we come in.

We cover a number of different services and solutions that allow you to streamline your insurance systems and administrative tasks so that you have fewer denials and more successful claims for your patients. That’s what will keep your customers coming back time and time again.

By decreasing the number of denials you get from insurance claims, you automatically increase your revenue by establishing a system that works and that your most valued customers can rely on. That helps improve your reputation in business and in your practice, as well as ensuring you are providing your patients with the help they need when they need it most.

Contact Us

For help regarding your medical billing services, contact us online or call 785-330-7288.

If you’re wondering what you can do to increase your bottom line, look at your billing system first. Is it working the way it should work for your practice? If not, the problem could be with your billing and insurance. Call us first and you will see that we put our money where our mouth is.

The post How to Prevent Claim Denials and Increase the Reputation of Your Practice appeared first on The Midland Group.

Inform Patients They Can Get Help

One of the key services that financial counselors offer is creating awareness. Not everyone is aware of patients’ financial counselors. Some patients have only heard of it, but they do not understand how they can benefit. It is the duty of a financial counselor to inform them of the help they can get. In addition to that, some may feel uncomfortable requesting help on their own. A financial counselor can help them get the assistance they need.

Determine Health Care Eligibility

Financial counselors help one determine if they are eligible for health coverage. For instance, for one to participate in Medicaid, they have to be from low-income families, children, pregnant women, and senior citizens. Therefore, a financial counselor will assess your situation and inform you if you are eligible. If you qualify, they also assist you in making an application. This makes it easy for healthcare providers as they do not have to turn away patients.

Educate Patients on Their Insurance Benefits

As much as people get health insurance, not all of them understand their benefits. That is where financial counselors come in. They offer help in the following ways:

• Inform patients about their benefits
• Educate them on the annual deductible that has been paid
• Explain to them the difference between copayment and coinsurance
• Inform them if there is any benefit cap
• Explain the total cost of the treatment they are about to undergo
• Inform them of their out-of-pocket expenses
• And tell them of the payment policy of the specific practice they are seeking treatment at.

Communicate With Insurance Companies and Payment

When one is sick in the hospital, they are concerned about how they will get better. However, one also has to make calls to the insurance company to ensure they are covered. This is where a patient financial counselor comes in. They act as a middle person between you and the insurance company. They will ensure that the amount to be paid by the company is settled and inform you if there is an out-of-pocket amount you need to pay.

Assess the Financial Needs of a Patient

A patient’s financial needs are not constant. Therefore, even as a financial counselor assesses the patient’s financial needs at the beginning of their treatment, they also have to do it regularly. That means scheduling meetings with patients and their family from time to time. For instance, there can be a change in the patient’s job status, insurance coverage, and other daily activities. With those changes, the patient’s payment plan has also been affected. Therefore, the counselor can help the patient come up with a better payment plan that suits the change.

Additionally, some patients assume that their treatment is based on their financial capability. This makes some patients reluctant to open up about their financial status. A financial counselor must establish trust with patients by communicating compassionately about payment policies and treatment plans.

Negotiate and Arrange Payment Plans

After a counselor has assessed the financial needs, they can help negotiate better deals for patients who are underinsured or in need. For instance, a counselor can work with a pharmaceutical firm with a patient assistance program that helps eligible individuals. They also work alongside pharmacy insurance programs, ensuring any prescribed medication is covered by one’s financial resources.

Having a financial counselor in your practice improves your patient’s experience in the hospital. You will enjoy increased revenue, and you do not need to have an uncomfortable discussion with patients about billing. If you are looking for financial counselor services for your practice, you can contact us at The Midland Group. We will help ensure you and your patients benefit from our services.

The post Top Ways Financial Counselors Help Patients Navigate Costly Care appeared first on The Midland Group.

1. Look Back on Previous Denials

Start categorizing and documenting all the data that you can about denials in general. The first step to stopping claim denials is understanding why you are being denied in the first place. Have your billing department set up a system to accomplish this so that you can refer to the tool to prevent them from happening in the future.

2. Specific Details

Claims are often denied due to generality, causing the insurance provider to interpret the claim themselves. Be specific by using a diagnosis code with the highest degree of specificity as possible. Make sure you complete provided information as much as you can so that your claim cannot be interpreted in a way from which the insurance company can benefit.

3. Always Verify First

One of the first things that you should do is obtain eligibility information before scheduling an appointment of any kind. Verification of insurance cuts down your number of claim denials right away because you can seek another reimbursement option before the patient has even received the care. This will not cause any extra waiting time for the patient because appointments are scheduled in advance anyways. Most authorizations come with a time window for which they are valid, so making sure that the appointment meets that timeframe is very important.

4. Timing Is Everything

If a claim is late, they are typically always denied immediately. If the hospital is extremely busy, it is easy to get backed up on denied claims. It is important to have proper safeguards in place so that claims are submitted on time. Multiple denials can be extremely hurtful, especially when expensive procedures have already taken place. The hospital should set up systems to verify that claims go out on time, and regularly monitor this process.

5. Seek Help

All hospitals and administrative departments deal with this daily. Claim denials are one of the most common lost income areas in a business, that’s why it’s so important to learn how to prevent claim denials. Working with an expert can help you identify and follow through with the process of submitting, processing, and collecting the claims. This will help you establish a system that will monitor exactly why denials are happening and ensure that they do not happen again in the future.

Now What?

As a third-party billing specialist, The Midland Group can help you with all of your claims. Our trained medical billing professionals are familiar with all the tools, rules, and documents needed to submit a successful insurance claim. Contact us today or book your free assessment to see how you can maximize all potential revenue surrounding all types of claims, including third-party liability.

The post How to Prevent Claim Denials appeared first on The Midland Group.

In the context of third-party billing, we believe that it is extremely important for providers to obtain reimbursement for their services within a reasonable amount of time. We also understand the necessity for third-party payers to have the chance to thoroughly scrutinize their responsibility in the payment of the claim and decide if the services provided are truly necessary.

According to the golden rule for third-party billing, there is no obligation to guarantee coverage or any other liability in the event that coverage lapses due to the third party’s failure to submit payment by the due date. Simply put, if a charge is not documented, you can not bill for it. When it comes to private payers, it is important to understand your third-party payer contract so as to avoid any lapses in reimbursement. 

Seven Tips To Understand Your Third-Party Payer Contract

• Know your rights. To avoid delays in payments that would cost you, be sure that you understand your rights when speaking about a contract and request a better explanation of the insurance provider’s payment schedule language if you don’t understand. 

• Define payment period for clean claims. Always make sure that there is a clause that holds the health plan responsible for paying any claims within a specific period of time. Without this clause, there is no obligation on the part of the health plan to pay the claim within a reasonable amount of time. During this step, make sure you ask for clarification on what a payer deems as a clean claim and if there are additional requests for information that is considered reasonable. 

• Define payment period for unclean claims. Make sure that you have a firm definition of the timeframe in which the health plan can return a claim as unclean. This will help avoid the health plan from holding unclean claims to delay any payments. The contract should also specify how much time will be allowed to review this additional information before any payments are made. 

• Address claims considered “not to file.” Your contract should require the health plan to acknowledge receipt of an electronic claim within 24 hours of receiving it. Failure to be acknowledged, the health plan should be contracted and the claim resubmitted. If the health plan states that they never received a claim, you will be able to provide documentation of the original file date and require that they pay within the guidelines that were stated in the contract. 

• Identify penalties. List what penalties are to be addressed when the health plan does not pay according to prompt-payment guidelines. State that participating provider discounts be waived and the health plan will be liable for 100% of billed charges plus interest. If not attainable, the health plan should be obligated for payment of the claim plus pre-set interest. 

• Protect your payment. Your contract should specify that all payments made are considered final unless the provider receives a written request within a specified period of time after receipt of payment. 
• Perform regular reviews. Always be sure to review your contracts regularly as most contracts have an automatic annual renewal. Check with your state regarding prompt-payment laws and request appropriate addendums to your contract before renewing.

Now What?

Providers are becoming better educated in the reimbursement process and state legislation. That’s why it’s crucial that you work with your third-party payers to help negotiate fair and equitable contracts. The Midland Group specializes in Third-Party Billing for Healthcare. As a third-party billing specialist, The Midland Group will submit, process, and collect all third-party liability claims necessary to collect as much revenue as possible for the hospital and to reduce the patient’s personal financial burden. Our trained medical billing professionals can help you optimize your billing system to increase revenue and improve the patient experience. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

The post 7 Ways To Understand Your Third-Party Payer Contract appeared first on The Midland Group.

What’s Causing Large Statement Balances?

A recent study showed that patient statement balances after insurance grew by more than 52 percent between 2012 and 2017. To break that down even further, that is an increase from 8 percent of the total statement to more than 12 percent. Approximately one-third of Americans can’t afford unexpected medical bills over $100 and many hospitals are struggling to find a solution to recuperate costs. 

Individuals who spent any time uninsured or who were underinsured reported to have problems paying large statement balances or said they would pay the medical debt over a long period of time. A quarter of those individuals who were always insured and did not meet the threshold of underinsurance also reported having problems paying their large statement balances.

Attempting to Collect Patient Payments

Many hospitals are attempting to collect payments from the patient at the time of service to address the problem of self-pay balances. The problem with that is that patients are usually at a loss for what their insurance will pay. Patients are typically going through very stressful situations where staff may feel uncomfortable trying to collect large payments. In addition, most hospitals don’t have the appropriate amount of staff or budget to follow up with patients by a phone call or mailing more than a couple of collection letters for their large statement balances. Other hospitals might not even have the technology or familiarity to offer payment plans or online payment options. 

Ways You Can Reduce Your Facility’s Outstanding Balances

One way that hospitals and providers can increase available resources is by participating in third-party early out solutions programs. Early out programs offer customer-oriented proceeding toward collecting balances from patients. Early out programs are very often successful with this because doing so is their main focus. In fact, early out programs are able to center their attention on patient collections at a much lower cost than a hospital trying to do the same. This is because hospitals would have to hire additional staff, pay for statement costs, credit card fees, additional phones and computers, employee benefits, and much more. 

Another way that you can reduce your facility’s outstanding balances is by making sure that the hospital leaders aim to implement a healthcare revenue cycle that is data-driven. This helps revenue cycle leaders to be able to know the hospital’s financial health of the organization. It also allows revenue cycle leaders to see if staff are performing their tasks efficiently to ensure quick reimbursements.

Offering Different Payment Options for Large Statement Balances

Early out solutions programs allow hospitals to offer more than one payment option to patients. Many individuals aren’t able to pay their large balance statements because of poor timing, lack of payment plan options, or having to pay for other bills. In addition, COVID-19 is now playing a huge role in financial hardships for individuals. Some may be experiencing a reduction of hours at their job, or some might be experiencing being unemployed altogether. 

When self-pay patients are notified of all of their options for payment plans, when they are educated about the financial assistance that is available to them, and when they are able to speak to someone on a personal level and someone who takes the time to sympathize with them to find a solution that works for them, they will be more likely pay and reduce large statement balances.

What’s Next?

With The Midland Group’s early-out program, patients are able to pay their financial obligation in full with no negative impact on their personal credit record or credit report. For hospitals, it is an opportunity to collect 100% of charges owed with greatly reduced administrative costs. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

The post As a Healthcare Facility, How Do I Reduce Large Statement Balances? appeared first on The Midland Group.

What Is OneClaim?

OneClaim is a program designed by the Midland Group to help relieve stress off of individuals by maximizing accident reimbursement for liability claims. In many cases, you might find yourself overwhelmed when trying to file the claims yourself. Typically, this is because there are numerous documents and checkpoints needed to make sure your claim application is filed correctly and in a timely manner. The good news? Our highly trained specialists will partner with patients from our partner hospitals to do all the work for you. We will investigate the accident, obtain any needed police reports, find out who’s at the fault for the accident, and much more – all at no cost to the patient. 

On the hospitals’ end, we also understand that auto accidents can be incredibly time-consuming. Since car accidents can take months (or even years) to settle, your facility may notice an increase in A/R days if claims aren’t submitted correctly and efficiently. With our experienced OneClaim specialists, we guarantee an average turnaround time of 21 days from claim submission to at least 90% reimbursement on accepted cases. When you partner with the Midland Group, you can be sure that your patients receive the maximum reimbursements they deserve.

Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

The post Get Help Paying For Your Accident-Related Hospital Bill with OneClaim appeared first on The Midland Group.

In January 2020, the Supreme Court passed the public charge rule, a policy that could deny immigrants a green card or visa if they are eligible or likely to benefit from forms of public assistance. As a result, many immigrants felt forced to choose between seeking healthcare and having a future in the United States. Although the U.S. Citizenship and Immigration Services (USCIS) have released additional information regarding the public charge rule, many immigrants have chosen to neglect their healthcare needs for fear of being denied permanent residence. As a matter of fact, a 2018 study reported that about 304,000 low-income citizens and green-card holders could be discouraged from seeking public benefits due to a lack of knowledge surrounding healthcare options. 

As you might expect, this confusion and fear amongst the immigrant population are especially heightened during the COVID-19 pandemic. As such, both patients and hospitals need to be informed about the extent of the public charge rule and what benefits are still available to immigrants. 

Who is at Risk?

Although many immigrants wonder how they could be affected by this new ruling, the Migration Policy Institute (MPI) estimates that less than 1 percent of the non-citizens in the United States could be denied a green card based on their current use of benefits. The only immigrants who could be denied green cards because of their benefits use include: 

• immigrants who are not yet legal permanent residents (LPRs) but receive cash benefits in certain states
• LPRs who leave the United States for six months or more at a time
• certain non-citizens who are not yet LPRs who are eligible for federally funded public benefits. For more detailed information about these categories, click here.

Getting All the Facts 

• The new public charge rule does not affect undocumented immigrants. As such, SOBRA Medicaid is still available for emergency healthcare and pregnancy-related healthcare. Seeking these services does not affect a person’s immigration status.
• For immigrants with documentation, the public charge rule only affects those who are seeking to further their immigration status. Anyone who uses public health benefits to pay for non-emergency treatments could be considered a public charge if they have received more than 12 months of coverage within the 36 months preceding their application for immigration or adjustment of status.  
• In response to COVID-19, USCIS clarified that immigrants in need of medical testing or treatment will not be penalized if they apply for green cards or visas. Additionally, the rule does not restrict access to vaccines for children or adults to prevent vaccine-preventable diseases. USCIS considers the receipt of public benefits as only one consideration in the totality of the immigrant’s circumstances over a period of time. Receiving benefits alone will not necessarily result in the denial of permanent citizenship.  

Here to Help

For over 30 years, The Midland Group has helped thousands of people qualify for public benefit. Our experienced patient advocates have not only helped countless patients apply for Medicaid and Medicare, they’ve also assisted patients in our partner hospitals apply for SOBRA. Since 1989, our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. In the midst of changing policies and unprecedented global healthcare challenges, The Midland Group stands by ready to assist patients in our partner hospitals to qualify for various public benefits programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. To learn more about our services, contact The Midland Group and see how your facility and your patients can benefit.

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Before the coronavirus pandemic, approximately 27.5 million Americans did not have health insurance. Since then, this number has increased dramatically. As businesses all over the country laid off close to 30 million U.S.workers, many more workers and their families have lost health coverage benefits. 

As a whole, COVID-19 has highlighted a significant gray area around healthcare billing, coding, resource allocation, and patient financial responsibility regarding coronavirus-related care. As such, it can be easy for people to get caught up in the whirlwind of ongoing updates and information regarding the specifics on coronavirus-related resources. 

To help you stay informed, our team has compiled a quick summary of the most important resources relating to the coronavirus and what that may mean for you and your family.

Families First Coronavirus Response Act (FFCRA)

In March 2020, Congress passed 2 stimulus bills aimed at assisting people without health coverage.

The first is the Families First Coronavirus Response Act. The FFCRA gave states the choice to use Medicaid to cover COVID-19 testing for those who are uninsured. While this testing covers both lab work and office visit, however, this bill does not help with actual treatment of COVID-19, should patients test positive.

While the Trump administration declined to reopen access to the Obamacare exchange, this concern did lead to the passing of another bill, the CARES Act.

Coronavirus Aid, Relief and Economic Security (CARES) Act

Complementary to the first bill, the CARES Act was designed to reimburse hospitals for coronavirus testing as well as necessary treatments for people who test positive. Reimbursements to healthcare providers are allocated from the bill’s $100 billion budget to be paid out at Medicare rates.

To qualify for reimbursement through this program, providers must have conducted testing and treatment on or after Feb. 4. In addition, providers must also complete the following steps: 

• Check the patient for coverage eligibility.
• Verify that the patient is truly uninsured and does not have any form of health care coverage, including any individual, Medicare, employer-sponsored, or Medicaid coverage.
• Confirm that no other payer source will reimburse the costs of testing and/or treatment conducted for the patient, whether partial or in full.

To learn more, visit COVID-19 Claims Reimbursement. In addition, providers can also begin the process to file reimbursement claims directly through the Claims Reimbursement Portal.

1135 Waivers for COVID-19

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) “using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers”. To help healthcare providers contain the spread of COVID-19 and address the financial issues presented, HHS has empowered the Centers for Medicare and Medicaid Services (CMS) to take proactive steps through 1135 waivers. In addition, the CMS has also been granted authority under section 1812(f) of the Social Security Act, which allows for blanket waivers to be implemented. When a blanket waiver is issued, providers are not required to apply for individual 1135 waivers. The blanket waiver related to coronavirus has a retroactive effective date of March 1, 2020 through the end of the emergency declaration. 

Examples of available waivers under section 1135 emergency authority include:

• Extend existing service authorizations until the end of the public health emergency
• Temporarily defer requirements for prior authorization
• Adjust specific timeline requirements for both state fair hearings and appeals
• Loosen deadlines for public notice and submissions in regards to specific Medicaid state plan amendments focused on COVID-19. This allows states to implement faster changes and thus ensure that they can be retroactive to the beginning of the emergency.
• Temporarily suspend prior authorization requirements;
• Extend existing authorizations for services through the end of the public health emergency;
• Modify certain timeline requirements for state fair hearings and appeals;
• Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and
• Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.

To learn more, visit COVID-19 Emergency Declaration Blanket Waivers for Health Care. For state-by-state 1135 waiver updates, visit Medicaid.gov’s Federal Disaster Resources. 

About the Midland Group

The Midland Group, in partnership with participating hospitals, is one of the very few companies that is able to deliver the highest returns from Medicaid and other public benefits. Since 1989, our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. Even in times of unprecedented emergencies, The Midland Group stands by ready to assist patients in our partner hospitals to qualify for various public benefits programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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