Access is helping patients obtain coverage
Here are some ways in which hospitals, including patient access areas, can connect patients to coverage under the Affordable Care Act (ACA) and secure a source of reimbursement for services, says Tricia Brooks, research associate professor and senior fellow at Georgetown University Center for Children and Families in Washington, DC:
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Administering hospital presumptive eligibility.
Just like the web site Healthcare.gov, state eligibility systems will need to mature, says Brooks. Presumptive eligibility for hospitals is one way to have uninsured people eligible for Medicaid enrolled quickly.
"The ACA gives hospitals the prerogative to make presumptive eligibility decisions," says Brooks. "States must implement the procedures and oversight mechanisms to support hospital presumptive eligibility."
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Supporting community-based consumer assistance.
"One way to do this is to provide space for assisters to work onsite," says Brooks. Patient access leaders also can set up an effective referral mechanism to ensure that the patient is connected with help.
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Offering space and support for outstationed Medicaid eligibility workers.
States are required by federal regulations to provide opportunities for individuals to apply for coverage in places other than government offices. "With new eligibility systems that qualify for enhanced federal match, eligibility positions are funded 75% by the federal government, compared to the previous 50%-50% administrative match," says Brooks.
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Becoming a certified application counselor entity.
Without certified application counselor status, says Brooks, patient access employees might find it more difficult to facilitate the process on behalf of the patient.
"Being a certified application counselor is like having the 'Good Housekeeping seal of approval,'" she explains. "It lets individuals know that the hospital is trained and part of a formal network of assisters."
