Using Medical Dictionary References Assignment (25 points, one point per

Scenario A redetermination is a review to find out if an individual still qualifies for Medicaid. Prior to the COVID-19 pandemic, this was required on an annual basis. Due to the pandemic, redeterminations were on pause since March 2020. Beginning June 2023, the redetermination process will again be required on an annual basis. See Governor Pritzker’s press release: Gov. Pritzker Encourages Illinois Medicaid Customers to Complete Renewals to Ensure Continued Coverage as Federal Pandemic-era Policies End. This impacts 700,000+ Medicaid recipients in the Chicagoland area. There are 3.7 million recipients in Illinois as of FY22. HFS plans to send a letter out to each patient this impacts. However, because the volume of patients is so large, providers are concerned about continuity of coverage. Providers are concerned as it impacts insurance coverage for patients who may be in the middle of an episode of care or who are unaware of the change because the state may have the wrong address on file and they may never receive the letter. Providers are also concerned at the large influx of patient inquiries and administrative support required to ensure a smooth transition of coverage for patients. Response Questions How should the VP of Front-end and VP of Back-end Revenue Cycle at a Health System in the Chicagoland area respond to this regulatory change? Be specific on what revenue cycle departments may be impacted. What approach would you take to find additional ways to help patients navigate this change? What would you communicate to other revenue cycle departments and physicians at your organization? What would you communicate to patients to help navigate this change? How would you go about getting consensus between Front-end and Back-end operations? Also, if patients are no longer covered by Medicaid, what are their options and what is the provider’s responsibility to assist? What financial metrics could be impacted and how could this impact reimbursement?

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