Utah ranks No. 1 in the United States in ratio of collections and savings to total Medicaid expenditures as reported by the federal Department of Health and Human Services' Health Care Financing Administration, according to a two-year study.
Only two other states - Florida and Alabama - were also characterized as having a highly successful third-party Medicaid collection agency.The Office of Recovery Services, directed by John Abbott, is primarily responsible for third-party collections. The office, which is under contract with the state Medicaid agency, the Division of Health Care Financing, is also recognized for its highly successful child-support collection program.
Collections and savings this year are expected to exceed $40 million, with operating costs below $1.5 million. More than $6 million will come from direct reimbursements from insurance companies, personal injury suits, double bills by providers, excess recipient income and fraudulent use of Medicaid.
The rest of the money is saved by a cost-avoidance approach of reviewing hospital and physician claims submitted to Medicaid. Using an extensive information gathering and storing system, claims are returned to providers with information to bill available insurance first.
"This is a valuable service to taxpayers and recipients," said Rod Be-tit, director of Health Care Financing. "In times of tight budgets, it is important that we maximize other resources to pay for medical services before Medicaid."