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Annual revenue collected for Medicaid patients has doubled at Trinity Regional Health System in Rock Island, IL, since January 2010, since the screening process is now done internally instead of by a contracted company.
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It is a truth universally acknowledged that health insurance companies can be a pain for patients. What may be a surprise is that hospitals often complain, too, for the same reasons: denied claims, low reimbursement, late reimbursement, and thickets of red tape.
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While many patient access departments can give patients the estimated full cost of a service, to date, very few are able to provide an accurate out-of-pocket estimate, says Becky Peters, regional director of patient access services for Sutter Health West Bay in San Francisco.
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Emergency department (ED) collections jumped from $55,000 to $120,000 annually after eligibility software was implemented at Mary Rutan Hospital in Bellefontaine, OH, reports John E. Kivimaki, director of patient accounts.
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For one month, patient access leaders at Witham Health Services in Lebanon, IN, targeted one simple but important change to improve the level of customer service given by registrars.
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The final rule for the fiscal 2013 Inpatient Prospective Payment System (IPPS), effective Oct. 1, 2012, continues the Centers for Medicare & Medicaid Services' (CMS) move to tie reimbursement to quality, rather than merely quantity, and makes it more important than ever for case managers to ensure that documentation in the medical record is complete and clearly reflects the patient's severity of illness, says Susan Wallace, MEd RHIA, CCS, CDIP, CCDS, director of compliance/inpatient consultant for Administrative Consultant Service, LLC, a healthcare consulting firm based in Shawnee, OK.
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These days, if hospitals don't have case managers in the emergency department, especially during peak hours, they run the risk of losing reimbursement as well as having their facility inundated with repeat users who don't have the resources to manage their healthcare in the community.
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Community Memorial Hospital's Intensive Case Management Program, which connects frequent emergency department users with appropriate community-based services, has decreased emergency department visits by 42% for a cost savings of $157,769, acute care admissions by 44%, saving $370,475, and reduced the average length of stay by 1.2 days for patients in the program at the 250-bed community hospital in Ventura, CA.
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Faced with a growing uninsured population, The MetroHealth System in Cleveland created an HMO-like system in 2010 to provide care for uninsured patients and embedded case managers in the health system's 11 clinics to ensure that uninsured patients get the care they need to avoid emergency department visits and hospitalization.
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The emergency department is evolving from being the gate of the hospital to being a front porch for the community, a central location where people with healthcare concerns can come and be triaged to the proper venue for care, says Karen Zander, RN, MS, CCMAC, FAAN, principal and co-owner of The Center for Case Management in Wellesley, MA.
