Case Study | Cloud-based Medicaid Billing Tracking Solution

Our journey

Kick Off

CHALLENGE

Efficiently track retroactive Medicaid bill status to enhance reimbursement.

ANALYSIS

Creating customized system layout to simplify retroactive Medicaid bill tracking.

SOLUTION

A cloud-based bill tracking solution to access the unworked reimbursements.

RESULT

Increased retroactive Medicaid reimbursement through effective monitoring.

Iteration
& Support

Our Journey

Challenge

Understanding Problems to Lead Change

Retroactive Medicaid coverage is one of the long-standing protection built into the program for low-income Medicaid recipients and their healthcare providers.

From the perspective of healthcare providers, the Retroactive Medicaid is a great initiative to maintain the continuity of administered care to those who cannot afford it.

Every day several self-pay encounters within a provider system become eligible for retroactive Medicaid reimbursement that are not tracked due to unavailability of a proper system.

Every day many retro-eligible encounters are missed and get expired because they weren’t discovered and billed in time.

A patient can go on to become a Medicaid recipient long after their initial visit. This makes their original encounter with the healthcare facility, eligible for Retroactive Medicaid reimbursement. But, tracking a huge number of past self-pay encounters on a daily basis to determine the patient's Retroactive Medicaid eligibility is a challenging task. Our client was a billing company in the US wanted an advanced bill tracking solution to track retroactive Medicaid reimbursement status.

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Analysis

Defining the Solid Roadmap

Our goal was to create a cloud-powered web application to monitor the reimbursable retroactive Medicaid encounters efficiently and help the healthcare facility users to get details about un-worked Items of the facility.

After brainstorming with the client, OSP proposed a comprehensive system which will be connected to existing system Azure database and actual web-application database.

The applications users can easily monitor the 'un-worked' items and manage only the status as Billed/Non-Billed.

OSP engineered a brilliant system architecture to view the list of unworked items with their count, billed to date, billed and non-billed status easily. Our finalized conceptual system design included in-depth architecture diagrams, report layouts, and screen designs. We have created a smart roadmap to connect their existing system Azure database and our web-application database to offer retroactive Medicaid reimbursement status.

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Solution

Delivering On the Promise

Accessing the client facility's unworked data was the biggest challenge. We smartly integrated the client's existing billing system' Azure database with our web-application database in order to access the 'unworked' reimbursement data of the client's facility.

We designed the system with an interactive dashboard that can showcase facility name, tracking count and smartly captured count with filter options.

We have worked diligently to create an easy-to-use web-based interface with designated user modules to manage status as Billed/Non-billed.

We ensured automated client ID mapping to associate the sublevel department with specific healthcare providers.

Our custom solution included advanced database management to manage the tracking count, captured and recovered reimbursements with activity tracking and alerts.

OSP' tailored retroactive Medicaid bill tracking solution provides daily monitoring of every self-pay and sliding fee encounter within the client's patient accounting system for the full length of its respective timely filing period. Our solution can capture the eligible retroactive Medicaid, it’s and sends timely alerts to the client's staff with all of the necessary billing detail needed for reimbursement. Our cloud-based and HIPAA-compliant solution offers date range-based payment reporting feature to view the audit trail past transactions.

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Result

Building to Deliver Experiences

OSP’ intelligent solution helped the client to enhance the reimbursement by examining all non-billed encounters for Medicaid eligibility and locate potentially billable encounters.

We adopted flexibility and client-centric approach in our work methodology to solve the significant challenges during the development phase.

OSP was managed to achieve 100% HIPAA compliance for patient data and system access.

OSP' cloud-centric retroactive Medicaid bill tracking solution enhanced the efficiency in monitoring each reimbursement encounters. We helped the client to boost the overall reimbursement by tracking each unworked reimbursement data. Our daily alerts feature enables sending automated email alerts to notify the client's billing team whenever an encounter becomes eligible for Retroactive Medicaid. With each alert, the billing team automatically receives the billing detail that needs to submit for reimbursement. OSP simplified the most challenging task of capturing all the retroactive Medicaid reimbursement that were going unnoticed and expired beyond their respective timely filing periods.

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