If you are an Oklahoma resident between the age of 19 to 64 with incomes up to 138% of the federal poverty level, you may be eligible. The annual gross income cap is $17,796 for a single person or $36,588 for a family of four. 

There are an estimated 200,000 additional Oklahomans that can get coverage with the expansion, including many adult males who were previously often ineligible under the old rules. Not only will patients have improved health outcomes under this program, but provider groups, hospitals, physicians, and more will benefit as well. 

July 1st through September 30th, new enrollees may get SoonerCare benefits that are coordinated by the Oklahoma Health Care Authority. On October 1st, 2021, OHCA plans to provide four private companies to coordinate care on behalf of the State. This will be a managed care program called SoonerSelect. 

Benefits of Medicaid Expansion

Having Medicaid expansion results in multiple economic benefits. It is proven that individuals who have medical insurance are more likely to get access to different preventative care options. This is crucial because a lot of individuals will leave their illnesses untreated if they cannot afford the cost of treatment. Insured individuals are less likely to go to the emergency room for an illness that is not an emergency, which saves money for both hospitals and patients. In addition, Medicaid expansion increases healthcare access for adults without children, parents, and low-income adults who are able to work. 

Now What?

The Midland Group is a trusted patient advocacy firm. We have worked with different facilities across the country and have seen firsthand the incredible benefits that accompany Medicaid expansion: for the patients, hospitals, and states. Our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. With over 30 years of experience, our team stands by ready to assist our partner hospitals to qualify their patients for various public benefit 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. Contact us today for more information regarding how we can help you. 

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In many states, hospitals and medical insurance companies can place a lien against a personal injury settlement. If the victim has filed a personal injury lawsuit, then the cost of the patient’s medical bills may be filed as a hospital lien against the settlement. Doctors are required to provide patients with care even if they cannot pay for it, which means they can put what’s called a lien against the patient’s settlement or judgment. This ensures that the doctors are compensated for the care that they provided to the patient.

What Is A Lien?

A lien is something that is put into place to ensure a person, group, or business is compensated for services or goods that are provided to someone else. If the patient filed a bodily injury insurance claim or personal injury lawsuit to recover the cost of their medical bills, the health insurer who paid for the medical costs may be able to file a lien against any proceeds from the patient’s lawsuit. This is known as subrogation. 

A medical lien demands repayment that is placed against your personal injury case. Whenever a personal injury lawsuit is filed, the amount of money the patient has already spent and could spend on future treatments are considered.

What Is A Hospital Lien?

Depending on the state an accident victim was treated in, hospitals and sometimes other medical providers can file a hospital or physician’s lien against an accident patient’s liability settlement or personal injury judgment. In states where other medical providers are not allowed by statute to file a lien, medical providers will ask the patient to sign a lien letter stating that they submit to a lien against their personal injury settlement. Where the law allows hospitals and/or other medical providers to file a lien, there are requirements that they must follow when placing a lien against the patient’s settlement.

• The lien must be filed within a specific time period, usually before the patient is paid from the settlement or judgment.
• The lien must have certain information included on it as defined by the state’s law, often including the patient’s proper name, correct address, the name and address of the hospital, the amount of the lien being claimed, and the dates of service.

Hospital staff must gather accurate information at the time of the patient’s accident-related intake or discharge. All liability insurance information, address, and names must be accurate. Inaccurate or the lack of adequate information can hinder a medical lien and make it difficult for a hospital to collect what is owed. If the hospital does not follow these requirements, their lien may not be enforced. One thing to consider is that it does not mean the patient is not responsible for the bills. This just means that the hospital may not be able to collect payment directly from the patient’s settlement. Further, if a patient has private health insurance, it must be billed first, and the lien can only be filed on any patient portion left over after the health insurer has made payment to the hospital.

Risky for Medical Care Providers

Providers and hospitals could wait years to receive their payment once a medical lien is placed, and the patient might not receive any damages once it’s all over with. Some hospitals will negotiate timely payments instead of getting a medical lien out against the patient to avoid this.

If a patient retains an attorney, the legal counselor can often negotiate with the hospital to reduce the amount of the lien. And in some states, the attorney may require the hospital to pay a pro-rata portion of his fees under the “Common Fund Doctrine.”. This is because the attorney is credited with creating the pool of funds from which the hospital is going to be paid, and therefore it is considered “fair” that the hospital pays the attorney for his or her efforts.

Cover Hospital Expenses

Many medical expenses can be covered by a personal injury lien. These expenses include:

• Nursing services
• All ambulance services
• Emergency room services
• Surgical expenses
• Medical supplies
• Physician services
• Dental services obtained in the hospital
• Drugs and medications
• Hospital services

Now What?

The professionals at the Midland Group understand the ins and outs of a hospital lien from both perspectives: that of the hospital and the patient. Contact us today to get the help you need during these difficult circumstances, or claim your FREE Accident Reimbursement Assessment & Custom Report tailored to YOUR facility!

The post What Is A Hospital Lien? appeared first on The Midland Group.

What Can Third-Party Billing Companies Offer?

Healthcare providers can identify how much they want to be involved in their operations and whether they want their staff to perform certain functions. Some organizations choose to use in-house processing, where providers cross-train employees and improve employee utilization by sharing job functions. Other organizations may not have the time or resources to do this, which is why they choose to outsource to a third-party billing company.

Each organization gets to choose what they want their third-party billing company to take over. The organization should prepare to bring its share of the necessary expertise to the table. An advantage of working with a third-party billing company is that they are typically more experienced with the overall knowledge of multiple player systems, such as Medicare, worker’s compensation policies, and commonly managed care plans. All third-party billing companies must have the technology and skilled staff to handle specific issues at any given point.

How Third-Party Billing Companies Can Improve Your Revenue Cycle

A healthy revenue cycle is crucial for maintaining the financial well being of your healthcare facility. One way to improve your revenue cycle is to reduce your facility’s AR days. Several factors that go into maintaining a healthy revenue cycle include effective scheduling, patient registration and eligibility checks, up-front payment collection (copayments and deductibles), claim management, medical billing, and billing follow-up. If any of those factors start to slip, the revenue cycle can be easily disrupted, causing an increase in AR days, which can be detrimental to your organization’s financial health.

When it comes to your organization’s financial well-being, billing operations is an essential aspect of what it takes to manage a healthy and thriving healthcare facility. If you find that your healthcare facility is struggling, there is still a chance to improve your revenue cycle process. It’s important to know what is wrong with your current revenue cycle process and outsource some functions to a reliable third-party billing company to help you resolve claims more effectively.

Now What?

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 are familiar with all the tools and pertinent documents needed to submit a third-party liability claim and successfully collect the amounts of money owed. We have a firm knowledge of all industry standards, clearinghouse procedures, and even the adjudication process.

Contact us today to learn about the many services we provide to help your hospital reduce AR days and gain maximum revenue.

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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.

It’s no surprise that Critical Access Hospitals nationwide are negatively impacted by COVID-19. As of November 2nd, Kansas has had 89,227 COVID-19 cases, 3,893 hospitalizations, and 1,046 statewide deaths. Just a few weeks ago, a rural hospital in southwestern Kansas was unable to care for a severely ill patient with COVID-19. The patient needed to be treated in the ICU, however, the closest ICU was completely full, and the nearest open ICU was seven hours away. Once there was eventually a spot in the closest ICU, the patient was in desperate need of being intubated and was starting to decline. The coronavirus is starting to get worse, and the Critical Access Hospitals are beginning to struggle.

What’s The Issue With Critical Access Hospitals?

Critical Access Hospitals are struggling the most during this pandemic because they are under the most financial distress. Over the past 15 years, 174 rural hospitals have had to close in the United States and the pandemic is only accelerating this trend. So far, 15 rural hospitals have closed in 2020 due to hospitals being forced to cancel elective surgeries, which is the main source of their revenue. Among the rural hospitals that remain, more than half of them don’t have an intensive care unit.

Before the pandemic hit, smaller hospitals were already unable to maintain their hospital status under the current payment system. “Rural areas have fewer commercial payers than more urban markets, which means these hospitals have a higher volume of state-funded healthcare with lower reimbursement rates,” according to Becker’s Hospital Review. Larger hospitals can dedicate individuals to deal with these difficulties of filing rules, which helps decide which facility receives the applicable reimbursement to be in their favor. Critical Access Hospitals lack resources in this department; therefore, they often miss out on various reimbursement opportunities which leads to financial distress.

How Midland On-Call Can Help Critical Access Hospitals

Here at The Midland Group, we believe that Critical Access Hospitals are not only vital in the creation of jobs and opportunities for communities, they also allow businesses to continue opening their doors. That is why we created Midland On-Call: Patient Advocacy and Self-Pay Solutions, which is reserved exclusively for Critical Access Hospitals. The Midland Group believes that Critical Access Hospitals should have the same resources and firepower that is traditionally reserved for large acute care hospitals and multi-provider-based healthcare systems.

Features of Midland On-Call Include:

Public Benefits Eligibility Solutions consisting of Medicaid Screening & Application Processing, SSI/SSDI, Crime Victims Compensation, etc.

Early Out Support which includes prompt-pay and negotiating payment plans.

Managed payment plans at no cost to your hospital.

Financial Assistance Screening and assistance with the application.

Accident Recovery Solutions consisting of PIP/Med-Pay capture, hospital lien filing, and Workers’ Compensation follow-up.

Annual 501(r) compliance consultation & legal review, ongoing business office training & support, and much more.

You get to choose how patient-centered resources are applied to your patient population.

Now What?

If you are part of a Critical Access Hospital and you’re struggling, know that you aren’t alone. The Midland Group has helped large and small facilities increase billing efficiency and maximize reimbursement rates. As a member of the Midland On-Call program, you can ensure that your patients are receiving the advocacy they need to qualify for public healthcare benefits and the information they need to resolve their self-pay balances with your hospital. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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