Eligibility screening: Is your organization ready for a fresh approach?
The message is getting through to healthcare organizations: screening self-pay patients for Medicaid, Social Security Disability Insurance (SSDI) and other programs is necessary given today’s economic environment. And with the future pointing toward Medicaid expansion under healthcare reform, most hospitals now provide some level of eligibility and enrollment assistance.
But while patient screening programs are becoming a revenue cycle staple, not every organization achieves the same results. The reason is likely in their approach.
To start, some hospitals don’t have an effective workflow in place to quickly screen patients. Depending on the time lag, patients may not be screened before they’re discharged, requiring them to return for financial services. In addition, hospital eligibility counselors may immediately try to qualify self-pay patients for the organization’s own charity care program, fearing the ramifications of an unpaid bill. As a last resort, if unsuccessful, counselors refer the patient to an internal or third-party eligibility specialist for Medicaid screening.
Organizations realizing the highest success rates in securing medical coverage for self-pay patients take the reverse approach. A specialist screens the uninsured or underinsured for programs like Medicaid or SSDI first, on the day they are admitted if at all possible. Background information gathered from the interview is then combined with medical records and knowledge of the patient’s financial circumstances so that an assessment can be made. With this approach, consultants can often begin the application process for qualified patients before they are discharged.
But the process doesn’t end when a patient is deemed potentially eligible for coverage. In fact, it’s just the beginning. Patients need an advocate who can guide them through the difficult application process and lengthy approval period, constantly monitoring the situation through follow-ups with the agency—all while keeping the patient well informed. And, of course, to be most effective, the service must be free for the patient.
For example, one large urban hospital that treated a relatively high number of self-pay patients was proud of its contributions to the community and particularly its robust charity program. Perhaps this is why the organization would first try to help needy patients receive internal financial assistance. Those it couldn’t help were turned over to a vendor that screened patients for Medicaid.
While the organization was achieving some success, leadership wondered if a fresh approach to eligibility and enrollment would have a greater financial impact. Turning the reigns over to a firm that visits patients on the day of admission and proactively screens for Medicaid eligibility, the hospital quickly realized that this approach was far superior. Internal staff was no longer overloaded by filtering patients through the screening process, only to be referred to a third party. And, aided by technology, the knowledgeable and committed eligibility specialists were able to screen 60 percent more accounts, translating into $10.2 million in just six months—far outpacing previous results.
Additionally, the organization benefited from the vendor’s commitment to pursuing high-dollar accounts. As a result, the hospital’s amount of revenue per approval jumped to $23,900 from an average of $15,700. But perhaps the crowning achievement came when it enrolled an individual with a $3 million account balance into Medicaid—essentially wiping the debt off the hospital’s books.
Former U.S. Joint Chiefs of Staff Chairman Colin Powell once said that the quote “if it ain't broke, don't fix it” is the slogan of the complacent. Have you taken a hard look at your eligibility and enrollment program’s performance lately? It might not be broken, but it likely can be improved with new techniques.
Ulrich Brechbühl serves as CEO of Chamberlin Edmonds, an Emdeon company. Atlanta-based Chamberlin Edmonds serves as a patient advocate providing custom-tailored eligibility services to hospitals nationwide.
