Challenge of a Non-Billable Patient Ratio

The Floating Hospital (TFH) is a Federally Qualified Health Center, providing 57,000 patient visits annually to homeless individuals and families from all New York City boroughs. Wherever possible, TFH bills the Medicaid program for medically necessary services; however, TFH provides services free of charge to patients not eligible for Medicaid or those covered under Medicaid managed care plans. The Capstone team analyzed TFH's reimbursement collection processes for homeless families with Medicaid fee-for-service coverage and discovered that TFH is unable to submit reimbursement claims for 48% of visits provided and is denied reimbursement for over 4% of submitted claims. To address these figures, the Capstone team identified factors contributing to TFH's 48% non-billable ratio, researched New York State Medicaid Policy, and conducted interviews with similar homeless healthcare providers. The team also conducted an assessment of intake and disenrollment processes to maximize workflow efficiencies at TFH clinics. Lastly, to enhance TFH's capacity to serve homeless patients, the team made recommendations to improve reimbursement through Medicaid.