Some denials can be overturned easily — maybe a piece of clinical documentation is missing. Other denials are a long shot, requiring lots of time and effort to challenge. For one Philadelphia-based health system, no mountain is too high to climb.
Researchers analyzed Medicaid claims data from 2017. They found 22.9% of patients with a homelessness code experienced coverage interruption at least once vs. 18.8% of Medicaid patients without a homelessness code. Other common reasons people lose their Medicaid coverage include income changes, residency changes, the insured is no longer pregnant, the insured’s children age out, noncompliance with status updates, or the insured is no longer disabled.
Delays can be caused by slow registrars, the need for interpreters, too many patients scheduled at the same time, or talkative patients, among many other things. To cut wait times, two centers in North Carolina have tackled these issues and more.
Healthcare professionals can find themselves in a quandary when they want to report fraud or other concerns within their organizations because doing so could require disclosure of protected health information. That could seem like a HIPAA violation; fortunately, there is a whistleblower exception that covers this scenario.