Some 'self-pays' already on Medicaid
Patient access staff at Trinity Regional Health System — Rock Island, IL put the first and last name and social security number of every self-pay patient into a verification website to see if they have Medicaid coverage.
"If you don’t verify coverage, you may bill for something that will be denied, or you may overlook coverage that the patient doesn’t know they have," says Linaka Kain, DE, disability examiner and Medicaid specialist. Here are the categories the patients fall into:
• The patient has active Medicaid coverage.
Sometimes patients insist they aren’t covered by Medicaid, but the verification system indicates otherwise.
"They tell us, I’m not insured and don’t have any money,’ but they actually do have coverage. They just don’t remember applying for it," she says.
• The patient doesn’t have current Medicaid coverage.
If Medicaid is not active, the patient becomes a self-pay. The registrar then fills out a form that is faxed to financial advocates, so they can screen the patient further.
• The patient once had Medicaid coverage, but it is not active.
"It’s interesting to see how people may have had coverage two weeks ago but this week, they don’t have it," says Kain. "It is ever-changing."
Kain says the most common reason Medicaid enrollees lose coverage is because they don’t update their information. "If it’s just a matter of recertifying, we have the patient call right away. A lot of times it’s a matter of [Department of Human Services] reinstating their coverage again, which is a quick fix," she says.
Patient access staff always emphasize to newly approved Medicaid patients that they will be asked to update their information periodically and they will need to do so to prevent a lapse in coverage.
• The patient is on temporary Medicaid.
This status can change from day to day, emphasizes Kain. "If they are deemed to have temporary coverage, they have the card to a certain date, but coverage can be denied within in that timeframe," says Kain. "Medicaid will tell the patient when the card is good through, but they will not tell us, the provider."
Verify every time
Illinois’ Medicaid program switched to yearly cards instead of monthly, as a cost-containment measure.
"The cards may say the patient is eligible, but that doesn’t mean it’s current," says Kain. "We have to verify the patient’s eligibility every time they come in, no matter what."
The same process is used for elder patients on Medicare, who often don’t realize that Medicaid is available to them as a secondary payer. "If Medicare pays 80% and Medicaid picks up the remaining 20%, it’s less out of pocket for the patient," says Kain. "We have to be vigilant to be sure we’re checking all avenues of coverage."
Recently, members of the patient access staff had to verify coverage by phone because the computers were down, and they found they’d forgotten how to do things the "old-fashioned" way.
"Staff needed to know the [National Provider Identifier] number for each entity, because they weren’t able to verify anything over the phone without it," says Kain. "Patient access should always have a plan B to know how to do something."
