The CBIZ Approach

At CBIZ KA Consulting Services, LLC (CBIZ) we believe that we do Eligibility Enhancement differently than others.  Our patient advocate approach and emphasis on doing the hard work separate us from the other firms in the eligibility space.  Below details the CBIZ approach and why our beliefs and values translate into better patient care and increased returns on investment for providers. Our approach differs from our competitors in the following manner:

  • First, we begin with the case workers .  Our multi-lingual staff is recruited with an eye on developing the empathy for the patient necessary for successfully qualifying them.  Our ability rests on building the level of trust with the patient.  To them, we are there to help them, not just acting as agents for the big, faceless hospital. This approach usually results in a greater level of cooperation as we prepare the necessary applications.  This partnership with the patient is a cornerstone of our success.
  • Second, better screening equals better results .  We have extensive data processing and clinical expertise in the firm which allows us to data mine for those patients who may not appear to qualify for Emergency Medicaid or Supplemental Security Income (SSI), but upon a deeper clinical review will.  We attribute our success in this area by applying the knowledge we have built in over 25 years of case mix management.  This allows us to target procedures and diagnoses which may not immediately qualify for these programs but upon further clinical review the underlying reasons for the episode of care become clear and qualification becomes easier.
  • Third,  clinicians, clinicians, clinicians.  We have the clinical staff to build the clinical documentation for qualification, thus relieving clients from this burden.  Not only does this improve throughput of these claims but it also makes for a better patient care environment.
  • Fourth, follow-through that works.  We are in the unique position to adjudicate issues that may come up relating to cases in which we have worked.  There are times that a valid insurance number is not enough; questions of medical necessity especially relating to length of stay are common.  We are  uniquely qualified to address these issues because of our multi-disciplinary staff addresses these types of claims as part of our normal process.
  • Fifth, we get it.  Most of our competitors focus on charity care or collection agency referrals because it’s easy.  We know that the hard work necessary to improve Medicaid Eligibility pays a second dividend, an increase in your disproportionate share payments.  Knowing how hospitals are paid keeps us focused and working for you.

We have a two-step approach for implementing our initiative with clients; the first is to recover as many missed Medicaid patients as possible, and the second is to build a process to ensure eligibility in the future.

Step 1 –   Review the Bad Debt file for missed Medicaid.

Step 2 –   Begin ongoing screening process to ensure eligibility and appropriate  Medicaid levels.

When we perform this review, we take your Bad Debt file, after it has been screened for Medicaid and the collection agencies have reviewed it, and then apply our process to find the hidden Medicaid and SSI cases.  We then work with the patients to prepare their cases for approval including gathering the necessary documentation from them and working with their medical records to collect the appropriate clinical documentation.  Once we have a Medicaid or SSI number we submit it to you for billing.

After we perform the Bad Debt file review we usually move to a more current enrollment process with our clients.  Under this process, after the client has screened the patient for Medicaid and SSI eligibility, the patient is then referred to us.  We work with the patient to determine eligibility and, as with the other processes, help prepare all of the documentation necessary for a successful application.  Like many of our consultative initiatives, CBIZ offers a variety of payment methods for Medicaid Eligibility that reflects the different needs of out clients. 

Guaranteeing our fees, we only collect compensation for this initiative based on our performance - the number of people we help enroll to Medicaid.

For more information our Eligibility Enhancement Services, contact Dora Marques at 609-918-0990 x 117.