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HANYS Solutions Partners with Cain & Associates to Help Hospitals Recover Lost Medicaid Revenue

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HANYS Solutions has partnered with Cain & Associates (C&A) to enable hospitals across New York to recover lost Medicaid revenue and identify much-needed opportunities to improve their bottom lines. In 2000, C&A began working with hospitals around the country, recovering more than $20 million in lost revenue for their clients. C&A is currently serving clients in New York, Virginia, Maryland, South Carolina, Ohio, and Kentucky.

C&A’s Medicaid Outlier Revenue Enhancement (MORE) product identifies Medicaid inpatient accounts that qualify for Medicaid outlier reimbursement, thus recouping lost Medicaid revenue. MORE ensures that hospitals receive the level of payment that they are entitled to for Medicaid-eligible patients. C&A uses state-specific algorithms and a proprietary process that can return millions of dollars in lost revenue back to a hospital. There are no upfront costs--fees are contingency based.

C&A’s MORE process is straightforward: The hospital sends Medicaid claims to C&A through a secure information exchange. C&A analyzes the data to determine claims that qualify as Medicaid outliers and returns qualifying claims to the hospital, which then re-bills the outlier claims to the state Medicaid program.

C&A’s expert team of utilization review nurses and physicians review the clinical documentation that supports the claims and handles the entire administrative process related to IPRO. C&A tracks all claims at every stage of the process and provides the hospital with status reports. C&A performs a six-year retrospective review of Medicaid inpatient claims and a two-year retrospective on Medicaid managed care inpatient claims.

For more information, contact Terry August, Director of Marketing, HANYS Solutions, at (518) 431-7652 or at taugust@hanys.org, or Scott Cain, C&A Chief Executive Officer, at (800) 817-2148 or at scain@cainandassociates.com. Contact: Terry August

Published June 5, 2009