Eligibility and Enrollment Management Solutions

Ott Cone & Redpath understands the difficulty healthcare providers, especially hospitals, face in reducing bad debt while maintaining exceptional patient care. That is why our professionals have worked with leading healthcare providers for over 30 years to develop customized solutions to reduce the number of self-pay accounts and increase revenues.

Enrollment and Recovery Solutions

Solutions include assisting providers in designing, implementing, managing, and improving in-house and outsource-based programs to increase the conversion of self-pay accounts to viable payment sources. The solutions are built on the foundations of our unparalleled knowledge of the legal requirements of the many potential payment sources.

Medicaid Eligibility

Medicaid is one of the most likely sources of insurance coverage for many uninsured patients. It is a highly complex, legal-based program that requires working closely with uninsured and underinsured patients to evaluate Medicaid eligibility and apply for coverage. The strength of our approach which has resulted in tremendous success for our clients is centered on a Patient Advocacy approach where qualified personnel assume full responsibility of the account and handle the processing of the patient’s Medicaid application. If the application is wrongfully denied, a patient is competently assisted through an administrative appeal. In addition to helping with issues that come up on individual accounts, we help hospitals address global Medicaid eligibility issues that create problems for hospitals and their patients. Our experience working with federal (CMS) and state Medicaid agencies and officials results in effective resolution to the many obstacles to eligibility.

Technology

Technology is also utilized to obtain analytics and guide solutions to enrollment and recovery obstacles. Our proprietary software allows our professionals to determine the specific issues preventing eligibility. It also gives our providers with customized reports required for effective management of an eligibility program.

Other Payment Sources

Other payment sources which we are highly skilled in identifying for purposes of reimbursement include:

  • COBRA
  • Crime Victims Compensation
  • Marketplace (Exchange) Insurance
  • Medicare
  • Private Insurance
  • Prisoner Medical Expenses
  • Third-Party Liability
  • Workers’ Compensation