Program Simplifies Medicaid Billing Process

Pathway Senior Living and Yardi Systems created a program that automates the once complicated Medicaid billing process. The Best of the Best winning Medicaid Billing Solution increased accuracy and decreased the amount of time staff must spend on Medicaid billing.

ALFA 2012 Best of the Best Winner

For Pathway Senior Living, as for other senior living providers, the process of obtaining state Medicaid reimbursement used to be a time-consuming chore that was rife with the potential for costly errors because it was mostly manual. That’s no longer the case.

Three years ago, Pathway approached Yardi Systems to collaborate on finding a way to fully automate the Medicaid billing process. The result is a software solution that can accommodate such nuances as differentiating between daily and monthly rates, as well as covered services versus private-pay. The system automatically takes state differences into account. It recalculates what is due when a hospital stay or resident income change affects reimbursement. It adjusts for complex scenarios such as take- backs in the appropriate Medicaid service month without compromising the current accounting period, and so on.

The new system is more efficient, reliable, and transparent than what came before. “To actually do the calculations, to create the report and to submit the report, [used to] take days because you’re talking hundreds of residents across the communities,” says Pathway CFO Michael Vick. “But with this product, that goes away. It creates the information so that we’re not having to do anything manual, and now staff time is better spent being able to focus on the residents.”

“Pathway had an intimate understanding of the intricacies of the Medicaid billing process, and of the ongoing challenges that the system posed. They also had the ingenuity to know that a better process could be developed. Through our collaborative efforts, we were successfully able to leverage Yardi’s software technology to greatly streamline the entire Medicaid billing process,” says Eric Kolber, vice president of senior housing for Yardi Systems.

Following Pathway’s successful Medicaid billing implementation, other Yardi customers also now take advantage of the system. “In fact, our other clients were so impressed by the system we built for Illinois that we have since extended it to accommodate the Medicaid billing nuances of just about every state. It’s all part of the integrated solution we now offer,” explains Kolber.

The above best practice was recognized as an ALFA 2012 Best of the Best Winner. Do you have a best practice, product, service or solution at your community or company that is advancing excellence in senior living? The Call for Nominations for the ALFA 2013 Best of the Best Awards will begin in November. Visit ALFA.org/bestofthebest to read more best practices.

Program Simplifies Medicaid Billing Process

ALFA 2012 Best of the Best Winner

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