How eMEVS Can Help OBGYN Challenges with Medicaid Members

Obstetricians and Gynecologists (OBGYN) play a vital role in women’s healthcare, offering services ranging from prenatal care to addressing various reproductive health issues. However, providing care to Medicaid members as an obstetrics and gynecologist presents unique challenges, including lower reimbursement rates and complex authorization processes. In this blog, we explore how the Electronic Medicaid Eligibility Verification System (eMEVS) can be a game-changer for OBGYNs in overcoming these challenges.

Medicaid is a crucial healthcare program in the United States that offers coverage to low-income individuals and families. While it’s essential for ensuring access to healthcare, OBGYNs often face hurdles when serving Medicaid beneficiaries. A nationally representative survey of OBGYNs sheds light on the challenges they encounter:

Reimbursement Rates: OBGYNs who accept Medicaid often find themselves dealing with lower reimbursement rates compared to private plans. Approximately 49% of surveyed providers noted that Medicaid reimbursement is considerably less, while 41% found it somewhat less.

Referral Difficulties: Finding specialists willing to accept Medicaid referrals is another obstacle. Nearly three out of four OBGYNs reported that it is either much harder (28%) or somewhat harder (45%) to locate specialists who accept Medicaid referrals compared to private insurance coverage.

Contraceptive Care Challenges: Providing contraceptive care to Medicaid beneficiaries can be limited. About 45% of OBGYNs reported needing prior authorization for specific contraceptives, and 33% could only prescribe a 30-day initial supply for some contraception methods.

Affordability Concerns: The issue of affordability frequently arises in patient-provider interactions. A significant majority of OBGYNs, approximately 91%, mentioned that affordability is a common topic during discussions with patients.

Cost Barriers: Cost serves as a significant reproductive care access barrier, with 55% of OBGYNs reporting that reproductive health services pose a significant financial burden on low-income patients.

To address these challenges, OBGYNs can turn to the electronic Medicaid eligibility verification system. But what exactly is an electronic Medicaid eligibility verification system, and how can it assist obstetrics and gynecology in navigating the complexities of Medicaid?

eMEVSPro: Unlocking Hidden Medicaid Revenue

eMEVSPro is an advanced technology that has unearthed millions in unpaid charges for healthcare providers, including OBGYNs. It’s a powerful tool in an era where Medicaid recovery is more crucial than ever due to the rising number of uninsured patients and tightening state budgets.

One of the primary functions of our electronic Medicaid eligibility verification system is to monitor and control services ordered and dispensed by high-volume providers. Here’s how it works:

Physician’s Requirement: Physicians may be mandated by the State to post prescriptions or laboratory test orders into the system as they are ordered.

Pharmacy and Laboratory Actions: Pharmacies and laboratories play a crucial role by clearing and deleting each order from the system as they fulfill it.

Record Keeping by eMEVSPro: The system maintains meticulous records of these transactions.

Denial of Payment for Unposted Services: eMEVSPro enables the State to deny payment for services that were not posted and cleared in the system.

Preventing Unnecessary Tests: It serves as a preventive measure against laboratories conducting extra, unnecessary tests.

Preventing Fraudulent Prescriptions: It also prevents pharmacies from processing prescriptions that were never written or those that were written using stolen prescription pads.

eMEVSPro offers a range of features to streamline the Medicaid eligibility verification process for OBGYNs:

Direct Connectivity: Seamless connection to the Multi-State Medicaid Fiscal Intermediary.

Batch Processing: Utilization of Multi-Level Batch Feeds for efficient processing.

Rapid Response: 24-hour response times via Batch.

Comprehensive Eligibility: Access Multi-Carrier Eligibility Response with Detailed Eligibility Coverage.

Maximized Discovery: Leverage Database Matching to uncover every possible insurance opportunity.

Account Segmentation: Facilitate the pursuit of Other State Patient Advocacy Programs.

Effortless Integration: Update your host EHR system with the latest insurance information to prepare claims for electronic submission.

Implementing eMEVSPro Automation

Implementing eMEVSPro eligibility verification automation in an Obstetrics and Gynecology practice involves several key steps:

Assessment and Planning: Define goals and assess current systems.

Integration: Collaborate to integrate eMEVSPro with existing systems.

Training: Educate staff on eMEVSPro usage.

Testing and Validation: Ensure error-free functionality.

Workflow Integration: Fit eMEVSPro into workflows.

Compliance and Reporting: Establish monitoring and reporting.

Go-Live and Monitoring: Gradual rollout and performance monitoring.

User Support and Optimization: Provide ongoing support and periodic assessment and enhancements.

By implementing our electronic Medicaid eligibility verification system (eMEVSPro), Obstetrics and Gynecology medical centers can reap several advantages:

Updated and Validated Data: Ensure insurance information is current and validated for all registrations before billing.

Reduced Denials: Experience a significant reduction in denials related to timely filing or non-covered services.

Increased Cash Flow: Boost revenue by identifying and claiming payments that would have otherwise gone unnoticed.

Lower Operational Costs: Save on expenses related to account follow-up.

Reduced Third-Party Costs: Minimize expenses paid to third-party vendors by decreasing the number of claims referred due to inappropriate denials.

Enhanced Efficiency: Increase efficiency within your OBGYN billing and insurance follow-up staff by eliminating unnecessary efforts.

Faster Cash Turnaround: Accelerate cash flow by 45-60 days, reducing days in accounts receivable.

Less Bad Debt: Decrease referrals to Bad-Debt collections.

Improved Visibility: Gain insights into staffing errors, enabling targeted training.

Enhanced Performance Metrics: Elevate your organization’s key performance metrics.

Obstetrics and Gynecology (OBGYN) face several challenges when providing care to Medicaid members, but eMEVSPro offers a comprehensive solution to streamline Medicaid eligibility verification, improve billing accuracy, and ultimately enhance the financial health of OBGYN practices. By leveraging this advanced technology, OBGYNs can focus more on delivering quality care to their patients without the burden of administrative complexities.