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Eligibility Services

Too often, the self-pay population in healthcare is relegated to write-offs, bad debt, charity care and/or collection activity. Although CBIZ understands and is familiar with these processes, we use our vast experience with data analytics to explore every opportunity to ensure that patients get their appropriate coverage. This creates win-win scenarios for patients and our client hospitals and firms.

As patient advocates, we’ve been involved in eligibility for decades. Our expertise in this area provides additional reimbursement for hospitals and third-party firms.

Eligibility Services for Providers

Day 1 Outsourced Eligibility Services

We provide financial screening at point-of-service with on-site coverage. Our multilingual staff meets the demographic needs of the specific community served. CBIZ qualifies and enrolls all beneficiaries for applicable federal, state and local programs. We screen, investigate and assist in the identification/qualification process for all patients. Our efforts include home visits, document collection, interpreting and visits to state and federal agencies. This creates a “win” for both patients and hospitals; patients get their entitled benefits and hospitals receive additional revenue. Additionally, CBIZ is certified to enroll patients in the Affordable Care Act insurance exchange; we are a CMS-certified application counselor designated organization (CACO).

Recoupment Analysis

We use an eligibility clearinghouse to find billable Medicaid for hospital clients, but this step is only the beginning of our Recoupment Analysis. Our professionals also examine bad debt or charity care files (depending on the state) and finds applicable programs to qualify patients. Using our qualifying techniques, we find patterns in hospital data that identify additional eligibility opportunities. Furthermore, as part of our Recoupment Analysis, we perform a complete assessment of these data files. This assessment generates additional revenue and creates an improved screening process. The Recoupment Analysis gets patients entitled benefits and reduces providers’ bad debt/write offs.

Self-Pay Solutions

CBIZ provides a full complement of self-pay services for providers, from point-of-service to pre-collection. Our approach ensures that patients are placed in applicable programs and that providers receive optimal reimbursement, finding areas throughout the self-pay process to add value for our hospitals and their patients. CBIZ analyzes accounts from all payers, from point-of-service to the collection phase. We offer direct third-party follow up, which includes follow-up phone calls from our call center, automatic letter writing functions, claim status establishment, payment arrangements, billing or-rebilling primary secondary payers and account review for potential secondary billing opportunities. We also provide self-pay denial and appeal services. We analyze denials to determine if there are grounds for appeal. Where necessary, CBIZ pursues appeals.

Back Office Services for Self-Pay Companies

CBIZ’s expertise with all aspects of the self-pay process can lead to ideal partnership opportunities. We can provide back office support in a variety of functions in the self-pay payment process. Our best-of-breed data analysis and expertise with patient enrollment programs provide additional value to companies and their client hospitals. Here are some of the services that CBIZ offers:

  • Follow-up phone calls
  • Automatic letter writing
  • Claims Status establishment
  • Payment arrangements
  • Billing or rebilling of secondary payers
  • Account reviews for secondary payers
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Key Contact
Dora Marques Dora Marques Executive Director