Public Provider Reimbursement

Monday, February 8, 2016

Situation

In 2004, as part of a broader reorganization within the Massachusetts Executive Office of Health and Human Services, our Center for Health Care Financing was asked to maximize state funds through consolidated revenue management across 10 health and human service agencies, including 23 state-owned facilities and four community-based programs statewide.

Solution

We responded by creating a single unit to maximize collection of federal and state dollars for health care and related services provided by public hospitals, mental health clinics, psychiatric hospitals, skilled nursing facilities and community-based programs.Key functions include:

  • Billing and accounts receivable management

  • Payment rate setting and cost reporting

  • Administrative claiming

  • Benefit coordination

Revenue is also obtained for the following services provided by community-based programs:

  • Targeted case management

  • Intensive residential treatment

  • Residential rehabilitation option

  • Home and community-based waiver

Our specific areas of expertise involve:

  • Management and administration of comprehensive medical billing services including resolution of unpaid claims

  • Identification, maintenance and coordination of health insurance benefits to obtain reimbursement from all liable payers

  • Synchronization of revenue management practices and the establishment of new payment methodologies

  • Data integrity enhancement and streamlined financial reporting

  • Development and establishment of new business models and best business practices

  • Utilization of private, state and federal resources

  • Compliance with state and federal laws, rules and regulations

Results

Today, we collect more than $1 billion in annual revenue for the Commonwealth of Massachusetts.