AVS Projects Robust Return on Investment Saves a State Millions

Solara Cochran

In August 2013, AutoGov began processing Asset Verification Service (AVS) requests for one of our very innovative and aggressive state government clients. After a successful implementation, the entire team was eager to hit the ground running. We were excited and astonished by the swift return on investment: within the first two hours of operation, the uncovered assets found by our solution paid for the entire program in cost savings.

To gain a greater insight into the meaning of this discovery, we must first understand the costs associated with leaving these assets unfound. Using the net present value of $76,000 as the annual cost of a normal long term care (LTC) Medicaid case, use of the AutoGov AVS solution found a great deal more than previous manual verification programs. In fact, the AVS requests produced over one million dollars in previously unknown depository assets, and the solution took, on average, less than 6 days to uncover well over one hundred submitted cases that exceeded the allowable state threshold for Medicaid.

Congress passed Section 1940 of the Social Security Act. This amendment requires states to implement an electronic Asset Verification System (AVS) for the aged, blind and disabled Medicaid population. AutoGov is on the forefront of innovation for integrated eligibility and program integrity, and our AVS project is one of only two fully implemented solutions in the country.

Until now, Medicaid applicants were only required to volunteer their banking information. As an individual, they could simply choose not to disclose a checking, savings, or certificate of deposit account. Medicaid case workers had no way to verify that applicants were fully disclosing all assets. It's a new day, and that is no longer true. With the help of AutoGov and our data partners, Medicaid caseworkers can be sure they are approving the right individuals.

AutoGov continues to uncover waste, fraud, and abuse for state and federal entitlement programs. For a quick and easy AVS implementation with very little upfront cost, contact Solara Cochran at (512) 439-2900 or email solara.cochran@autogov.com.

CaseVue Best Practices

Solara Cochran

Successful "real world" examples from our Long-Term Care Customers

Healthcare organizations hire AutoGov to help improve in their admission processes. We can help them by providing a decision assistance tool that will predict the probability of a Medicaid approval in an extremely successful and timely format. Because of our software, AutoGov clients save millions of dollars in write-offs annually.

Customer examples:

One client story begins with a resident referral coming in from the hospital. The Business Office Manager (BOM) utilizes CaseVue with nearly every potential admission. The BOM immediately runs a CaseVue score with the information provided from her referral source. Depending on the admission process (including the CaseVue risk score), that referral can be accepted or denied inside of their policy-based 15-minute time frame. The patient's CaseVue score was helpful in determining that the potential resident would need to address just a few assets before the state would grant an approval. The CaseVue risk score was 56%. Standing in the way of approval, CaseVue uncovered some property in a completely different state. The resident would not qualify for Medicaid without selling the property and beginning a spend-down plan. The family didn't realize their mother owned any property, let alone in another state. Without CaseVue, the state would have denied the residents Medicaid application. In this state, a denial usually takes about 6 months. CaseVue saved everyone involved in the case time and money!!

CaseVue is also helpful in detecting potential fraud. A resident referral was sent to a Long-Term Care Nursing Home by a community resource. The potential resident admitted to being Medicaid Pending and as part of their admission process, the facility administrator ran a CaseVue score. CaseVue returned a score of 0% but verified the Social Security Number to be that of an actual person, one who was deceased. The nursing home was able to avoid potential losses in the hundreds of thousands. Admission was denied due to fraud.

CaseVue, helping real-people make real-world admission decisions!

AutoGov Releases Updated Risk Management Software for Medicaid and Healthcare Reform

Taylor Phillips

Leveraging analytics driven by more than 30 million cases, CaseVue allows healthcare providers, states and insurance companies with a comprehensive solution to managing risk in eligibility, enrollment and insurance exchanges.

CaseVue v5.0

Quote startCaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility, enrollment and exchange decisions.Quote end

Austin, Texas (PRWEB) January 14, 2013

AutoGov Director of Technology and Analytics, Taylor Phillips; announced today a major release of his company’s flagship healthcare risk management software, CaseVue 5.0. This important version introduces improvements and tools designed to ensure that information necessary for Medicaid eligibility and enrollment is available in real time on a caseworker’s desktop.

Business office managers and caseworkers are often saddled with making decisions without the benefit of data necessary to prevent mistakes or errors. In these times of rate pressure and uncertainty in the healthcare reimbursement structure, mistakes and errors often mean money – significant write-offs and even fines. Phillips says, “CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility and enrollment decisions.” CaseVue gathers case data and fuses information from third party data providers to feed an algorithm designed facilitate decisions. A remarkably fast turnaround…this process takes less than one second.

Thanks to AutoGov’s new financial partner, Ontario, Canada based Fusebill (fusebill.com); CaseVue can now be priced to suit our client’s needs – by the score, in packages or on a monthly basis! AutoGov’s specialists can create a custom pricing structure to support any healthcare business.

The software also features new self-service sign-up, administration, training and reporting designed by Phillips and an amazing development team at Rochester, NY based Netsmartz (netsmartz.net).

CaseVue is part of a comprehensive platform used by healthcare providers and government agencies to provide decision support solutions with a base in predictive analytics. CaseVue provides users with fast, accurate decision support tools that improve both the timeliness and quality of eligibility, enrollment and exchange related decisions.

AutoGov’s CaseVue software has provided scores to healthcare providers and government organizations since its launch in 2005. AutoGov’s algorithms are informed by data mining and statistical analysis of more than 30 million Medicaid, Food Stamp and TANF cases. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day-to-day operations without major disruption or unnecessary expense.

Contact one of AutoGov’s CaseVue specialists for a demonstration at 512-439-2900 or sign your company up today at http://www.casevue.com.

Resources For Finding an Assisted Living Facility

Cherish Morgan

                The search for the perfect Assisted Living facility for your loved one can be time consuming and confusing. With so many options, it’s hard to know where to start or how to begin to narrow down the search. There are many resources on the web for you to be able to check out and do research. We have gathered 3 websites that have important information to be able to make this process easier for you.

Memberofthefamily.net - http://www.memberofthefamily.net/

This website offers a rating system of 16,000+ Medicare/Medicaid- certified nursing homes across the United States. You can also look at a national watch list they have compiled. This can help you build a list of possible facilities and know which ones you should steer clear of.

AARP- http://aarp.us/wl1QsR

AARP is a valuable and respected site for senior citizens. The link above will take you to an article on “The “Do’s” of Due Diligence” concerning choosing a nursing home. Before you start the nursing home selection process, you should know what it is you are looking for and how to find it.

Medicare.gov - http://1.usa.gov/zuWwn4

Medicare.gov has compiled a detailed check list for you to be able to take it with you on your assisted living search. It offers questions to ask, reminders of what to look for, a detailed area for recording information gathered, and a rating system.


Hopefully these websites answer any questions you may have on choosing the best assisted living facility and make the process less confusing and less time consuming.




Making Sense of Medicaid

Cherish Morgan

Medicaid and Medicare are a maze of rules and regulations. For ordinary citizens, Medicaid can seem like a chemistry experiment that only an expert can do.

I have noticed that the term “spend down” when talking about Medicaid long term care can cause a lot of confusion for people. The explanation is full of jargon and confusing rules.

Today though, I came across this article that explains what a “spend down” means, and provides a detailed account of how it works.

“Contrary to standard procedure when investing for retirement, where you are looking to maximize your   assets, under the spend-down, the government, before it will pay, is looking not to how you have maximized your assets but to how much is left.” Excerpt from “Column: Making sense of the Medicaid spend-down”

Getting educated and prepared for the adventure of applying for Medicaid is the hardest part. There are a plethora of stories, articles, and/or blogs that you can find to help break down the government “lingo” and can steer you on the right path with less frustration and confusion. Here’s one we recommend:

To read the article mentioned above, “Column: Making sense of the Medicaid spend-down”, visit http://bit.ly/uWz4aZ.

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