Contracting services for Hospitals
Department objective: To reduce hospital write-offs stemming from patients who receive care and do not have the means to pay their medical bills.
If you are currently experiencing losses due to CMSP and Medi-Cal write-offs, then “MRS Hospital Contracting Services Department” is the solution to your financial shortcomings. MRS will reduce your facilities write-offs and reduce the time your staff spends processing and collecting CMSP and Medi-Cal cases.
The need for our services are most often derived from a patients procrastination regarding the completion of their application (30 day maximum in most cases). MRS services can also be the derivative of a patient lacking the appropriate guidance once released from the hospital, receiving incorrect or insufficient information from County Eligibility Workers.
Also, the belief they just would not qualify, personal fear that causes the patient to misrepresent themselves and their financial situation during the application process, and the incapacitation or death of the patient can lead to unpaid services rendered by the hospital. These unpaid services only add to the escalating need for the professional services provided by Medi-Cal Regulation Specialists to reduce these unnecessary write-offs.
How We Can Help
MRS proposes a working partnership with your hospital. MRS will provide your facility with an MRS representative that will complete applications on behalf of the patients who are unable to pay for the care they receive. Our “In House” Consultants will effectively provide guidance regarding County Medical Services Program (CMSP) and Medi-Cal Services. These programs are a stable means, if used efficiently, to substantially limit the write-offs of private pay patients.
When your hospital provides service to private pay patients, MRS will make contact with the patient before they leave the hospital (when possible), or as soon as MRS receives patient information from the hospital staff. It is the responsibility of MRS, not your facility, to coordinate the completion of the CMSP or Medi-Cal application process with these patients. The situation calls for prompt initiation of the application process, due to the limited window of opportunity of thirty days or less in most cases.
Some community hospitals employ or receive Outstation Eligibility Workers from the Department of Health Services. Kathryn Humphres, Owner of MRS, worked as an Outstation Worker, as part of her work assignment when employed by DHS. As a representative of DHS she would receive applications from inpatients.
Rarely was it necessary for a follow through by the county DHS or the hospital staff to assist the patient in providing the necessary documents to complete the process; usually resulting in a denial for benefits. Our services provide the entire application process beginning with the application, then working with the county and the applicant, and always being personally involved until the application has been approved.
Examples of Our Contracting Services
The following are examples in which the client/patient received approval from CMSP or Medi-Cal, when without MRS services, the client most likely would have been denied and the facility would have accrued another write-off. Prior to meeting MRS these individuals were pessimistic about eligibility due to being over asset limits and other property concerns.
The first had filed for Medi-Cal benefits after an emergency room visit. The clients’ condition deteriorated rapidly and was readmitted to the hospital. His leg was then amputated and he required heavy medication. He was unable to attend to his own affairs. The family of the patient had no Power of Attorney, and his initial Medi-Cal application was denied due to a property issue.
The patient then contacted two attorneys. One proposed that the patient file bankruptcy and the other referred him to MRS. MRS immediately filed for a fair hearing based on our knowledge of regulation #50402 “unavailability of property due to incapacitation.” The county Human Services Department denied our position. MRS then called the Medi-Cal Property Analyst with the State of California who agreed with our position that the property should be considered unavailable. MRS then restated our position with the county and gave the county the name and phone number of the State Analyst, suggesting they contact him personally. Upon further review, the county immediately approved the client’s Medi-Cal benefits back to the original application date.
The next scenario involved a patient who needed surgery immediately. He was admitted to a local hospital. Doctors found a brain tumor and deemed he needed surgery as soon as possible to be performed at Stanford Medical Center, and because of the absence of insurance, the hospital would not perform the operation. This patient’s Medi-Cal application was denied due to assets. This gentleman’s family contacted a lawyer, who then referred them to MRS. MRS then worked to reposition his assets to obtain eligibility. The key to this situation however, was that because Stanford Medical Center knew that MRS was working on the application process, they performed the surgery on the patient before actually receiving approval for Medi-Cal.
These examples show just a few of the benefits that can be achieved through a working partnership with Medi-Cal Regulation Specialists and your hospital. Contracted services range from one to five days a week of “In-Service” Representation. MRS contract amounts are based on flat fees or percentages of recovery. Please contact Les Vanderpool, the Vice President of MRS and Coordinator of all hospital contracts.
You can reach him toll-free at 877-677-6334.