Retro Medicaid Revenue Recovery
Transform Bad Debt into Recovered Revenue
Retro Medicaid Revenue Recovery transforms how hospitals handle late Medicaid eligibility discovery. Our solution helps you recover revenue that would otherwise be lost to administrative oversight.
The Challenge
Hospitals lose millions annually when Medicaid-eligible accounts go unidentified. Patients who weren’t eligible for Medicaid during treatment may qualify later, but these opportunities often go undiscovered, resulting in unnecessary write-offs and lost revenue. Hospitals may also lose DSH funding if they fail to report the required amount of DSH days.
Our Solution
Retro Medicaid Revenue Recovery combines advanced eligibility verification technology with expert analysis to identify and recover Medicaid-eligible accounts that would otherwise be lost to bad debt or charity care. By identifying more retroactive Medicaid claims, hospitals are also able to increase their eligible DSH days.
Why It Matters
- Recover millions in lost revenue without increasing patient volume
- Improve your hospital’s financial health with minimal operational impact
- Reduce administrative burden on your billing staff
- Maintain compliance with state and federal regulations and ensure full DSH funding
How it Works
- Monthly Eligibility Verification: We perform comprehensive late Medicaid eligibility checks on your accounts.
- Expert Analysis & Reporting: We provide detailed reports identifying recoverable revenue opportunities.
- Ongoing Identification: We conduct monthly checks so you meet timely billing requirements.
Customer Success Stories
Case Study 1
Hospital Discovers $500K+ in Missed Medicaid Revenue
The Challenge
A North Carolina hospital had never implemented a systematic 365-day Medicaid eligibility lookback process for their bad debt accounts. Like many hospitals, they were unaware that patients often become Medicaid-eligible after discharge due to changes in financial circumstances.
The Discovery
While working with this hospital on HASP debt relief compliance, RetroCheck discovered they weren’t capturing retroactive Medicaid reimbursements. We offered a complimentary analysis of their bad debt files to demonstrate the potential.
The Results
Our analysis uncovered hundreds of thousands of dollars in immediate Medicaid reimbursement opportunities that had been sitting in their bad debt files. The hospital was able to file these claims right away, generating substantial cash flow.
The Impact
The recovered revenue from this single analysis will pay for more than 10 years of RetroCheck’s monthly service. Essentially, our client is now receiving ongoing Medicaid discovery as a free benefit while continuing to recover additional revenue each month.
From the customer
“We had no idea how much money we were leaving on the table. RetroCheck’s discovery process immediately improved our cash flow.” – Hospital CFO
Case Study 2
Hospital Saves $100K+ Annually by Switching to Flat-Fee Model
The Situation
A regional hospital was already running 365-day Medicaid lookbacks through a competitor who charged a 10% contingency fee on all findings. While they were recovering some revenue, the costs were substantial and difficult to predict.
The Problem
The hospital was paying over $100,000 annually in contingency fees and spending administrative time auditing charges to ensure accuracy. The unpredictable costs made budgeting difficult.
The Solution
RetroCheck demonstrated how our flat monthly fee model could deliver the same (or better) results at a fraction of the cost. The hospital made the switch within a few months.
The Savings Breakdown
- Previous annual cost: $120,000+ in contingency fees
- RetroCheck annual cost: $18,000 flat fee
- Annual savings: $100,000+
- Additional benefit: Eliminated administrative overhead of auditing contingency charges
The Bottom Line
This hospital now saves over $100,000 annually while receiving the same quality Medicaid discovery service, plus they’ve freed up their billing staff from the burden of auditing contingency fee calculations.
Frequently Asked Questions
What level of staff involvement is required to generate a RetroCheck report?
We’ve designed a straightforward 3-step onboarding process to guide your staff in preparing the necessary file type for an efficient review of potential Medicaid eligible accounts. With extensive experience in medical billing, we have streamlined this process to minimize the workload on your staff.
How long does it take to receive a report?
Our turnaround time is influenced by the North Carolina Medicaid databases we work with. Typically, we request at least three days to review and process files. However, our goal is always to exceed expectations with timely delivery.
Why don’t you charge a contingency fee? Isn’t your pricing unusually low?
Transparency and honesty are core to our values, and our mission is to help all North Carolina hospitals maximize access to Medicaid benefits. Our pricing is fair and straightforward and avoids contingency fees, offering predictable costs without surprises. Essentially, we keep it simple for us and for you!
We already have a retro Medicaid vendor. Why would we still need RetroCheck?
Many hospitals already use vendors that focus on standard retroactive Medicaid eligibility. RetroCheck is different because it was specifically designed to identify delayed Medicaid eligibility that occurs months after service but still within recoverable filing timelines. In many cases, these later eligibility events represent recoveries traditional retro vendors never identify.
Ready to Transform Your Revenue Recovery?
Take the first step toward optimizing your hospital’s revenue cycle. Contact RetroCheck today for a free consultation and discover how our solutions can help your organization:
Maximize revenue recoveryEnsure HASP complianceStreamline operationsReduce administrative burden