Taking eligibility in-house proves too
costly for hospital

Dropcap400-bed hospital dismissed The MASH Program as its eligibility partner after a 12-month contract, choosing to pursue its self pay accounts through an
in-house unit. Seven months later, the hospital invited MASH to return.

The Background

This not-for-profit, religious teaching hospital had not had an eligibility partner before hiring The MASH Program in 2006. Sixteen percent of the state's residents are uninsured, and fourteen percent of the hospital's patients were eligible for Medicaid. As a result of MASH's work, the hospital was reimbursed nearly $400,000 over the next 12 months – considered the slimmest period of eligibility partner results because of long certification time-lines at certain agencies.

The Challenge

As is the case with hospitals across the country, the hospital found itself with increasing financial challenges. The administration leased all revenue cycle processes to a management firm, which engaged its own inexpensive call center to locate and process self-pay patient accounts.

The Response

Over the next seven months, the hospital watched as certifications and reimbursements went down, and patient satisfaction and financial services employee morale dipped. The administration discovered that paying increasing MASH invoices had been the result of receiving increasing reimbursements.

The hospital asked The MASH Program to look at its eligibility needs again. Because MASH had other hospitals in the area, a team of MASH professionals was immediately available to return to the hospital – at the same contingency rate as seven months previously. A new contract was written, and the MASH team slipped seamlessly back into the hospital's system.

The Results

Just eight months after returning to the hospital, MASH had assisted 515 patients to successfully complete their certification processes, resulting in nearly $525,000 in reimbursements to the hospital.

In total, this hospital has received reimbursements covering $10.8 million in charges as a result of MASH's efforts since 2006.