Digging into the data, UMass Medical School third party liability programs uncover millions in savings for Medicaid programs

September 13, 2017

At a time when state Medicaid budgets are under increasing pressure, UMass Medical School is saving hundreds of millions of dollars for states across the country through its third party liability work.

Experts on third party liability at the medical school’s Center for Health Care Financing work with state Medicaid programs to both reduce costs and boost revenue.

With deep backgrounds in both academia and state health care programs, the team digs into the data and compares federal and state records to search out whether Medicaid enrollees who may also be covered by commercial health insurance plans.

Experts search out other insurers to help share the costs of care, and as a result have saved millions for Massachusetts and other states. In particular, the team works to identify comprehensive commercial coverage for medically complex patients, who can consume a large portion of health care dollars.

The team also zeroes in on “missed” Medicare coverage for low-income seniors on Medicaid, partners with Medicaid to recover money spent on patient care, and helps low-income residents buy employer sponsored health insurance.

Top examples of UMass Medical School savings for state Medicaid clients include:

  • $500 million for the state of Massachusetts, identifying commercial coverage that Medicaid members were also entitled to and recovering costs from those insurers. Similar efforts have netted more than $200 million for Medicaid plans in other states.
  • $64 million in cost avoidance in fiscal 2017 for one state Medicaid plan through partnerships with specialty hospitals that helped identify other commercial coverage possibilities.
  • $28 million in savings for one state as a result of Medicare premium overpayments for seniors who were eligible for Medicaid.

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