Report 45 - Title XIX Eligibility Termination Report

This report, which can be run on a quarterly or other periodic basis as defined by the client, identifies those Title XIX recipients who have lost eligibility for any reason.

Of particular interest for Reimbursement Directors are those individuals who were granted temporary eligibility for Emergency services (typically a delivery), who were not citizens of the United States, and therefore have no social security number. The MMIS automatically generates a “system generated cancellation for Alien eligibility”. These individuals should be removed from any sampling done by the Fiscal Intermediary, or specifically noted in the work papers, when determining what adjustment, if any, should be made for those patients whom the hospital is unable to prove have Medicare Part A as well.

From a revenue management perspective, this report identifies those former Title XIX recipients who lost eligibility for reasons with a reasonable likelihood of reversal when “worked” by either the Hospital Social Services department or an external vendor who can perform this function on an “outsourced” basis. Whoever receives and acts on this report, the critical issue to resolve is to assist the recipient in re-establishing Medicaid eligibility before the next hospital admission, clinic visit or other related provider visit. By proactively managing the eligibility of this demographic subgroup the Hospital not only provides a quantifiable community benefit, but ensures that it, and its affiliated facilities and medical groups optimize both their billing revenue and DSH reimbursement.