Medicaid Revenue Loss From Unit, Census, and Eligibility Errors

$10,000-$30,000 annually from Medicaid claim denials, write-offs, and delayed reimbursement due to unit, census, or eligibility errors caught post-submission • $10,000-$35,000 per year from MCO-denied units and rework • $10,000–$30,000 annually from premature discharges billed to Medicaid when Medicare Part A was still active; delayed unit submissions after discharge

Administrator maintains separate payer matrix in Excel; manual verification of VA vs. Medicaid primary payer status before claim submission; phone calls to VA facility coordinators to confirm eligibility; paper files tracking benefit verification dates • Administrator negotiates payer with hospice agency via phone/email; manual tracking of which services are hospice-covered vs. facility-covered in Word documents; nursing staff use separate documentation sheets for hospice vs. facility billing units • Administrator tracks length-of-stay manually to determine when to discharge from facility system; therapy staff document units in paper logs that are manually transcribed into EHR; post-discharge reconciliation of billed units vs. delivered units via Excel comparison