Eligibility Conversion Program

DECO offers an array of Programs to assist any facility. These Programs can be modified and customized to address any nuance required by the Client.

Unlike other vendors, we focus on ALL of the financial leakage, not just the low hanging fruit. As a result, our improvements to net patient service revenues produce more revenue than the competition.

DECO provides RESULTS

Eligibility Programs

DECO provides the qualified staff necessary on-site to perform detailed in-house review and bedside interviews to determine if patient is a viable candidate for Medical Assistance, and if so to assist the patient/guarantor with the application process for Medical Assistance. This assistance includes the necessary investigation, fieldwork, and administrative work needed to assist the patient in meeting eligibility requirements for Medicaid or other applicable Federal, State or local programs.

Personal/Self-Pay Conversion Management
     • Patient Advocate Approach
     • Inpatient and Outpatient eligibility placements
     • Field visit to patient home to gather pertinent
       documents/information/signatures if necessary
     • Transport patient to Social Services Department
       appointment, if necessary
     • Hand deliver applications, if appropriate
     • Work Denials and Appeals

Medicaid
State/County/Parish Indigent Coverage
QMB/SLMB
SSI/SSDI Disability
Children’s Health Initiative Programs (CHIP)
State Children’s Health Insurance Programs (SCHIP)
Chronically Ill & Disabled Children (CIDC)
Veteran’s Administration
Cervical and Breast Cancer Programs
International Payment on Foreign Nationals
Vocational Rehabilitation
COBRA
Third Party Liability
Federal Crime Victims Compensation/Victims of Violent Crime
Miscellaneous Private Policies
Indian Health Services
Long Term Care/Nursing Home Placement
Internal Charity
Add Baby Account

Benefits for Many:
     • Patient
          – Caring for their financial health too!!
     • Physicians
          – Appreciate the care for the patients, and their AR!!
     • Community
          – Great PR for the Hospital
          – More money circulating throughout community
     • Hospital’s Bottom Line
          – Real dollars hit the bottom line
          – Disproportionate Share/Cost Report benefits
     • Successfully increased facility revenues in EVERY                 client.
     • Consistently out perform the competitionTOP

SOCIAL SECURITY DISABILITY PROGRAM

DECO will review Client’s admissions and help patients pursue SSI and SSDI Social Security Disability claims regardless of current payer status. Patients need not be self-pay to be accepted into this program. In addition to the Self-pay patients, DECO staff can accept referrals and screen admissions from areas of the facility not traditionally referred to an eligibility vendor, including specific areas of the facility i.e. Renal Department, Kidney Dialysis, Psych and associated clinics, and assist the patient through this process.

Convert ANY patient to SSI/SSDI Disability

          – Open to ALL Patient Financial Classes
          – Available to Clinics and Physician Offices
          – Available for Long Term Care/Nursing
             Homes/NICU (Low birth-weight babies)
          – DECO provides necessary in-services for Social            Workers, UR, associated clinics, etc.

Benefits for Patient and Facility

Patient receives a monthly incomePatient is eligible for Medicaid and/or ultimately MedicarePatient has resources to obtain treatment and medicationsPatient may be eligible to receive food and housing assistanceHospital can be reimbursed by MedicaidAfter 2 years, SSI recipients are eligible for Medicare which reimburses faster and for more servicesHospital image is improved in community
Potential Disproportionate Share benefit for facilityTOP

MEDICAID BILLING AND DENIALS

DECO has resources dedicated to the pursuit of payment on denied claims. DECO will, upon the request of the client, pursue denied claims generated as a result of the Eligibility process.

• Medicaid Billing and Follow-up

      – Denial Management
      – Re-billing
      – In and/or Out-of-State primary Medicaid
         receivablesTOP

ANCILLARY PROGRAMS

• QMB/SLMB
• Long Term Care Placements
• Out-of-State Provider Enrollment and Billing, third party
• Retrospective Certifications
• CommunityCARE Referral/Authorization Form
Tracking & Verification TOP