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Case Study Shows DCMA
When It Comes to Patient Care
Can Help Address Reimbursement
Create an Environment of Pride
Issues for Members

About six weeks ago, I decided to go primari-
The Dade County carrier had reached back out ly vegan. No particular reason. It just seemed
Medical Association to DCMA staff and confirmed healthier. I am happy to say I am doing well on
(DCMA) has used this they were addressing the situ- the new regiment. Eating out can be tricky, but
forum in the past to ation. A week later we for the most part the experiment has been suc-
implore our members to received notification that the cessful. Before the change, I decided to take one
utilize our association to carrier identified over more trip to my favorite fast food joint. As I
take action to defend $38,000 in improper denials waited in the drive thru to get my chicken sand-
against the inappropriate that were being reprocessed wich, I noticed an older vehicle with a Chic fil
reimbursement practices and sent to the physician. A license plat on the front of it. As I paid for my
of insurance companies. This case study illustrates food, I asked, “who loves this place so much,
A recent success story that physicians do not have they have your logo on the front of their car?”
with the Medicaid pro- to accept improper reim- and pointed in the direction of the vehicle. The BY JAY JUFFRE
gram highlights how bursement from insurance reply impressed me, “Oh, that’s our cook, he
effective we can be when BY FRASER COBBE carriers. The DCMA can has been working here since we opened and
working together. assist in routing your con- has so much pride in what he does that he asked for that a couple years
This case study cerns to the proper channels ago.” Isn’t that so awesome? That an hourly employee enjoys where he
involves a local pediatrician who reached for resolution. works so much, he would ask to advertise it to the world? There is a per-
out to our organization for assistance. He Furthermore, this study illustrates that centage of the working population (about 25%) who really wants to have
was an in-network physician for one of the AHCA is living up to their promise to hold a true sense of purpose in what they do and desires to take pride in achiev-
local Medicaid Managed Care carriers. He insurance carriers accountable for the ing their best every day. Patients will never be happier than your employ-
was experiencing recurring issues with delivery of care to Medicaid Beneficiaries ees. Want your organization to excel at patient care in 2020? Create an
denials for Well Visits and Vaccination as long as physicians and the associations environment in which your team can be delighted to work and only hire
Administration for his pediatric Medicaid that represent them utilize the complaint people who want to be part of it. Study key indicators like employee
beneficiaries. The issues dated back sever- portal they have established. engagement and turnover to determine how you are doing. Constantly
al months and he was unable to resolve If you have reimbursement issues with seek feedback from the team and adjust and respond as required. You’ll
the issue working through his contacts. any insurance carriers, please reach out to know you have arrived when employees are asking you for license plates
While the DCMA would like to take the DCMA so we can help. and bumper stickers to tell the world how much pride they have in work-
some credit for the outcome, the real cred- ing for your organization.
it goes to the Agency for Health Care For more information please visit
Administration (AHCA) and their com- www.miamimed.com. Jay Juffre is Executive Vice President, ImageFIRST. For more information on
mitment to hold Medicaid Managed Care ImageFIRST, call 1-800-932-7472 or visit www.imagefirst.com.
Carriers accountable. Fraser Cobbe is Executive Director of the
By utilizing AHCA’s complaint portal, Dade County Medical Association.
the DCMA submitted documentation to For more information, contact the DCMA
AHCA who in turn routed the concern at (305) 324-8717.
directly to the carrier. Within 72 hours the

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South Florida Hospital News southfloridahospitalnews.com January 2020 13