Cook County Health's savvy revenue cycle plan

Medicaid on paper and a stethoscope

Although many safety-net hospital systems have benefited from the expansion of Medicaid coverage as a result of the Affordable Care Act, they still must be skillful at revenue cycle management in order to operationally stay afloat.

That's the experience of Cook County Health and Hospitals System in Chicago. Forty-one percent of the patients treated by the system are covered by Medicaid while another 37 percent are uninsured, according to Becker's Hospital Review. It spends as much as $500 million a year on uncompensated care.

Safety-net hospitals around the country struggle with their expenses despite the Medicaid expansion. That's partly due to cuts in the disproportionate share hospital (DSH) program. That has been mitigated to a small extent by the improving economy, which has helped safety net hospitals even in the 18 states that have yet to expand Medicaid eligibility under the ACA.

While Medicaid expansion “is extremely positive for our patients and the precise intent of healthcare reform...it comes at a price for safety-net providers as we must create a more robust revenue cycle process to receive payment from a multitude of managed care organizations for the care we provide,” Doug Elwell, Cook County Health's deputy chief executive officer of finance and strategy, told Becker's.

According to Elwell, that includes keeping Cook County Health atop of niche coding issues (such as obtaining reimbursement from a variety of Medicaid managed care organizations) and providing coordinated care programs for the uninsured (to prevent them becoming seriously ill and much more expensive to treat).