It has long been believed that providers choose not to enroll in Medicaid programs because of lower reimbursement rates for services as compared to private insurers and Medicare. Unfortunately, even with a desire to serve everyone, regardless of payment method, there are bottom lines to worry about that can impact provider decisions to enroll in Medicaid programs.
Additionally, there are some circumstances in which Medicaid payments never make it to physicians and their practices at all. Due to the complexity of healthcare billing, the potential for denied claims and revenue never being collected, it is estimated that physicians lose 17 percent of Medicaid revenue to billing problems. This is compared to an estimated loss of five percent to Medicare and as low as three percent to private insurers.
While there’s no denying compensation plays a role in the decision, recent research suggests there are other hurdles keeping provider enrollment low. Well-documented administrative burdens from program enrollment to claims management are daunting to busy, already overworked providers and can keep even the most willing from venturing into the Medicaid space.
At FEI, we believe willing and qualified providers should be able to enroll, receive credentials and ultimately manage claims quickly and easily in one place. Our comprehensive provider services management portal serves as a one-stop-shop for both providers and program administrators serving some of the most vulnerable populations in the communities you serve.
HURDLES TO JUMP
Provider enrollment criteria for Medicaid vary widely by state. While there are overarching guidelines from the U.S. Centers for Medicare & Medicaid Services (CMS), each state has the flexibility to set additional or more stringent requirements for providers because of the Affordable Care Act. Medicaid Provider Enrollment Requirements Frequently Asked Questions (cms.gov)
A lack of enrollment criteria consistency across states makes access to care challenging, especially for Medicaid members seeking specialized treatment, as enrollment criteria for an out-of-state specialist may not match where the member resides. This also makes it harder for physicians offering niche services and care to expand care to a larger pool of Medicaid patients unless they are enrolled in multiple state Medicaid programs.
Additionally, submitting claims once enrolled and the ongoing dealings with Medicaid for reimbursement compound the enrollment challenges. When a Medicaid claim is denied – an estimated 25 percent of the time – physicians are left with two options. They can forego the revenue or fight for it in a lengthy appeal process.
Things aren’t much easier on the state side, and the program administrator challenges directly impact the ease at which providers can enroll. Some of the biggest hurdles states face include:
- Cumbersome enrollment processes that are solely handled by state employees
- Provider application volume is outpacing enrollment throughput capacity
- Paper-based processes increase the chance of errors and delay enrollment
- Existing processing systems often require numerous touchpoints from state staff with limited automation
- Application errors are often detected after submission requiring a back-and-forth submit, review, resubmit and re-review
At FEI, we simply can’t let enrollment delays and cumbersome administrative tasks for qualified providers keep Medicaid members from getting the care they need and deserve. We’ve listened to provider communities and overhauled the daunting application processes that place enormous strain on state staff and providers, because we believe the enrollment process should be empowering, efficient — and even exciting. That’s why we designed our Blue Compass provider management system with a strong focus on provider outcomes.
SIMPLIFY PROGRAM ENROLLMENT AND OVERSIGHT
FEI’s Blue Compass suite of solutions includes a host of interoperable systems and modules designed to address common requirements while meeting the unique and complex needs of each customer. Core offerings include case management for long-term services and supports (LTSS), behavioral health case management and a provider management system. Additionally, our Blue Compass suite includes sub-modules and ancillary services to provide flexibility and meet ever-changing customer needs.
The Blue Compass provider management system is a comprehensive, one-stop-shop for provider needs, agency surveillance and provider oversight. Configurable to meet state or agency-specific provider qualification and management needs, the system is tailored for individual clients. Additionally, automated tracking and data visualization system dashboards increase transparency for both providers and state staff.
Providers can easily access an online portal to enroll, apply for credentials and update their information. Applications are pre-configured to meet their specific provider type and revalidation can occur right in the same system when required. Additionally, once enrolled, providers can use the portal to view claim status and member eligibility.
For state and agency staff, the Blue Compass provider management system helps facilitate provider screening, credentialing, and all enrollment activities, tracking enrollment status, viewing claim status and member eligibility and access to payment information and remittance advices. Authorized staff within a provider’s organization can access information about Medicaid beneficiaries served and manage staff working for their organization. Users can access payment information from the Medicaid Management Information Systems (MMIS), view reports on services and recipients, and submit feedback.
With the right technology solutions, our customers can streamline what has traditionally been an administrative hassle and help their members get the care they need and deserve more quickly. Willing and able providers deserve a simplified way to qualify for serving the most vulnerable members of the populations our customers serve.
For more information about the Blue Compass provider management system or to schedule a demo of the product, please visit www.feisystems.com.
