How complex is patient's situation?
How complex is patient's situation?
Advocates answer detailed questions
At University of Utah Health Care in Salt Lake City, financial counseling is handled in two ways, depending on the complexity of the patient's question, says Katie Harwood, CHAM, admissions manager over financial advocates and ED registration.
"Registration staff in our admitting areas inpatient and emergency room can answer basic questions about benefits and payment arrangements, and take payments," Harwood says.
If the patient has more detailed questions, he or she is referred to the hospital's pre-service financial advocate team, who give information on the final bill amount for a specific service, price estimates, and previous balances.
"The admitting registrars for inpatient and outpatient scheduled procedures are located in the same area as financial advocates, so they are readily available," adds Harwood. These steps occur:
Members of the pre-service financial advocate team contact patients scheduled for inpatient and outpatient procedures.
"They complete a pre-registration interview, advise them of their patient responsibility, collect deposits, and explain the payment plan options," says Harwood.
Patients that have been identified as self-pay and those with a patient responsibility after insurance are routed to the financial counselor.
All self-pay patients are screened for Medicaid or other coverage options.
"In addition to screening for Medicaid, we identify if other payment options are available, such as COBRA, crime victims, or auto insurance," says Harwood. "For pharmacy, we refer them to the pharmacy assistance programs."
If there is no coverage, counselors create a cost estimate based on the CPT code.
"We require a 50% deposit of estimated charges for scheduled procedures," says Harwood.
If patients cannot pay for the service, the patient's provider is contacted to determine if the service meets medical necessity to proceed without a deposit.
"If the service is deemed necessary by the provider, a Certificate of Medical Necessity is completed," says Harwood. "This is sent to the medical director, who makes a final decision." [The form is included with the online version of this month's Hospital Access Management.]
Self-pays verified
When a self-pay patient presents at UK HealthCare in Lexington, KY, financial counselors go to the patient's room to verify that the patient is truly self-pay.
"Sometimes the patient does not have their card with them. We later find out that the 'self-pay' has third-party coverage," says Jack Smarr, MHA, associate director of revenue management.
A true self-pay is patient is asked questions and screened for Medicaid coverage. If the person is eligible, the counselors start the application process immediately. "These people are put into 'Medicaid pending' status," says Smarr. Financial counselors follow up to ensure that the patients complete their application, though a coverage determination might take weeks.
"Those that are not eligible for Medicaid or disability are also screened for financial assistance to be put on a sliding scale of payment," says Smarr. "This process of collecting information for financial assistance takes cooperation with the patients and a lot of follow-up with our financial counselors."
At University of Utah Health Care in Salt Lake City, financial counseling is handled in two ways, depending on the complexity of the patient's question, says Katie Harwood, CHAM, admissions manager over financial advocates and ED registration.Subscribe Now for Access
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