Patient access capturing $12M more in revenue: Convert self-pays to Medicaid
Patient access capturing $12M more in revenue: Convert self-pays to Medicaid
Patients are surprised and grateful
About 15% to 20% of self-pay patients qualify for Medicaid, which represents more than $12 million in gross revenue, at Riverside Regional Medical Center in Newport News, VA.
"We currently have a vendor onsite to review our self-pay population for Medicaid and disability," reports Robin Woodward, CHAM, director of patient access. "We also request that all self-pay patients apply for Medicaid prior to applying for our charity care program."
Scheduled self-pay patients are pre-registered, given an estimate of their out-of-pocket responsibility, and asked to pay upfront or establish a payment plan. If unable to pay, patients are asked to apply for Medicaid and bring a denial letter if they aren't eligible.
Many patients assume they won't qualify but comply with the requirement, and many are surprised to learn that they are, in fact, eligible. "Patients are appreciative when they find they have coverage for current services and in some cases, retroactive coverage," says Woodward. "Some patients would never have applied if not for our process." Patient access staff members take these steps:
Staff members use an automated price estimator for the non-scheduled self-pay population.
If patients are unable to pay estimated amounts in full or by setting up a payment plan, the patient access financial specialist discusses charity and Medicaid application requirements with the patient.
Staff members collect demographic information from patients and find out the urgency of the tests or procedure the patient is having.
"If a patient has a previous balance, the patient is referred to an onsite vendor to discuss the Medicaid application at that time," says Woodward.
Hospital/patient partnership
Patient access leaders developed a financial assistance program two years ago at Nash Healthcare Associates in Rocky Mount, NC.
"Our community had quite an adjustment to getting on board with their financial responsibilities," says Kathy Watson, CAM, supervisor of outpatient services. "We found that we needed to help our patients understand what they could do and where there was help."
Patients are referred through the pre-arrival department or care management. "We want to make sure that our patients understand that we offer services to help assist them with their financial obligations," says Watson.
One counselor helps outpatients set up payments or obtain other financial assistance, another counselor assists Emergency Care Center patients, and a third counselor visits admitted patients to discuss financial services. "We have developed a fair and clearly understood program to help our patients who need financial assistance," says Watson. "The program emphasizes a hospital-patient partnership." These steps occur:
When the patient is referred, an email is sent to the financial counselor in that department.
The patients are contacted by the counselors and a financial application is completed, covering employment status, dependents, and assets.
The application determines if the patient falls within established Federal Poverty Level guidelines and meets criteria for Medicaid referral.
If the patient is Medicaid-eligible, the counselor might complete the application or the patient might be referred to an outside vendor specializing in assisting patients with the completion of Medicaid applications.
Follow-up is key
Linking uninsured patients to Medicaid/Supplemental Security Income (SSI) coverage or to hospital-funded charity care will remain a major focus for today's patient access departments, says Lindsay Rubin, director of Huron Healthcare, a Chicago-based consulting organization specializing in performance improvement.
"Even for those hospitals and systems that are high-performing in their revenue cycle, the current landscape of healthcare necessitates that hospitals stay focused on these financial counseling efforts," she says.
Discussing financial coverage options with uninsured patients before their services or prior to discharge for urgent or emergent hospital stays increases the likelihood that patients will follow up and get coverage or obtain charity care, says Rubin. Patient access managers need to monitor that follow-up is occurring as needed, both with state offices and by patients themselves, she emphasizes.
Without diligent follow-up, patients often are confused by the arduous process of qualifying for coverage. "This holds true regardless if financial counseling functions are managed through a vendor or through hospital employees," says Rubin.
Woodward says that if patients choose not to follow up, they are billed as normal, and they might miss the opportunity for Medicaid and/or charity consideration. "We put this process on the patient," she says. "If it's still within the time period for possible Medicaid or charity, we will ask our onsite vendor to meet with them. Otherwise, they will go through normal billing processes."
In-house or outsource?
Patient access staff can do a lot to ensure that the patient does not "slip through the cracks" when attempting to qualify, says Rubin. Each department needs to evaluate the most cost-effective way of doing this step, she says.
"We have assisted clients in moving from an outsourced financial counseling model to in-house and vice versa," she says. "Many variables should be analyzed in making this determination."
These variables include cost of labor, vendor performance, and the hospital's overall ability to effectively manage vendor inventories and qualitative performance, says Rubin. "While there is no one-size-fits-all model, providers that are in high labor cost markets may outsource to reduce labor costs," she advises. "Also, some providers may not have the in-house expertise."
In these cases, relying on a vendor with local market expertise might be a better solution. However, some patient access departments already possess much of this knowledge in-house due to assisting patients with the hospital's charity application process. "Staff can easily be repurposed to expand their skill set, allowing them to assist patients with qualifying for a variety of sponsorship options," says Rubin.
Sources
For more information about determining eligibility for Medicaid, contact:
Kathy Watson, CAM, Supervisor, Outpatient Services, Patient Access, Nash Healthcare Associates, Rocky Mount, NC. Phone: (252) 962-8407. Fax: (252) 962-8956. Email: [email protected].
Robin Woodward, CHAM, Director, Patient Access, Riverside Regional Medical Center, Newport News, VA. Phone: (757) 594-4211. Fax: (757) 594-4495. Email: [email protected].
Lindsay Rubin, Director, Huron Healthcare, Chicago. Phone: (503) 530-4804. Email: [email protected].
About 15% to 20% of self-pay patients qualify for Medicaid, which represents more than $12 million in gross revenue, at Riverside Regional Medical Center in Newport News, VA.Subscribe Now for Access
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