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Financial Assistance within Reach for Patients and Hospitals with Automated Screening

By Steve Millhouse, Product Manager, SearchAmerica, A part of Experian

Many patients need financial assistance to cover their medical costs, and this population is growing quickly. This fact is well agreed upon within the healthcare community, especially as under-insured and uninsured patient populations increase daily.

The challenge is to correctly identify these patients accurately and quickly enroll them in the programs designed to assist them. Every day a hospital’s financial and admissions staff must assess:

-          Does this patient qualify for financial assistance?

-          Which program(s) do they qualify for?

-          Which program(s) does the hospital prefer to enroll the patient in (e.g., which programs will provide the best payback on their services)?

-          How quickly can the hospital complete their screening and enrollment process?

Good questions. What the industry needs are answers. The answer for many is automation.

There are many advantages and lessons to be learned by the hundreds of hospitals who are using technology to streamline the screening and enrollment process for numerous financial assistance programs. In recent years, hospitals have used automated screening and enrollment processes to identify more than five million patients who qualified for various financial assistance programs. Without automation, individuals may not have been identified as candidates or enrolled in a program. They would have received medical bills that they couldn’t afford, and the hospitals would have seen many of these accounts sent to collections and never recovered.

Financial Accounts are Triaged Too
Physicians routinely balance their time between numerous patients, serving those in the most critical need of care first. Financial counselors are no different. Their growing caseload requires them to select patient accounts that need the most attention, either they have the most dire financial circumstances or have a diagnosis that will result in costly medical treatment.  These staff members need to keep the hospital’s best interests in mind and maximize their recovery while serving out the hospital’s mission.

But, what about the remaining patient files that do not reach the top of the list, or perhaps don’t even make it the financial counselor’s desk? It is not the fault of the financial counselors, they are serving as many as they can. Instead, it is a symptom of an outdated process in need of a cure.

Hospitals and patients alike have much to gain by pursuing financial assistance with these accounts. It would greatly reduce their bad debt, as patients in financial need will be unable to pay their bills even if they wish to, and the hospital could gain much good will by setting a patient’s mind at ease regarding financial matters and enable them to focus more attention on their health.

Living Their Mission
In 2009, the United States’ healthcare system will need to treat even more patients who cannot pay for their services, in full or part. Rising unemployment, high deductible health plans, and increasing medical fees contribute to this unfortunate trend.

This is challenging news for hospitals as they seek to serve out their mission of providing healthcare to all in need within their communities. However, a hospital’s doors cannot remain open if it is not reimbursed for its services. Today’s headlines speak of hospitals needing to reduce their services or cut their workforces as the economic crisis deepens.

Hospital administrators know that they must be frugal with their finances as well as initiate new processes to secure timely payments from the patient or another party. Automation of the financial assistance screening and enrollment process is part of a hospital’s mission to care for its neighborhood.

Manual Processes Are Not Up to the Challenge
Many healthcare networks have chosen to tweak existing registration and collection processes, adding staff or rewriting enrollment forms. The results are minimal and ultimately frustrate the patient and financial counselors, who are in need of help. To improve the entire financial assistance screening and enrollment process, hospitals must directly face the following challenges:

·         Facilitate how they identify patients as potential program candidates

·         Verify a patient’s financial situation

·         Simplify the complex program eligibility rules and requirements

·         Minimize the time needed to complete the screening and enrollment processes

Today’s manual processes used to screen and/or enroll patients for financial assistance programs is usually plagued with paperwork, long patient interviews, and performed indiscriminately. As with any manual process, consistency is unattainable and human errors will occur.

Adding to this complexity, not all financial assistance programs are created equal. Some will pay out more than others to the hospital, making them more attractive. Or, the hospital may need to direct patients to their hospital charity care programs to fulfill quotas. These program attributes must play an important role in the process.

So, the hospital needs to not only triage the patient accounts but match them with the best alternative. This is no easy task to be performed manually. Patients may qualify for many financial assistance programs, and the hospital’s bottom line may depend on which program they choose.

Automated Financial Screening Works
Not surprisingly, hospitals are rethinking how they screen patients for third-party financial assistance or their charity program as well as automating the process. As healthcare networks overhaul their registration processes to automatically alert registrars and financial counselors of accounts likely to qualify for financial assistance, they are seeing measurable results.

Novant Health has more than tripled its number of charity cases and experienced a 50% decline in bad debt after automating its screening processes. In addition it reduced charity enrollment process time by 90 percent.

For with proper automation, healthcare networks can gain:

·         Improved efficiencies in screening and enrolling patients

·         Significant reduction in financial counselor interview times

·         Financial reimbursement that otherwise may have not occurred

·         Qualify a higher percentage of patients into appropriate programs

Technology can capture the complex eligibility rules of financial assistance programs to provide simplified screening for many programs, including:

·         Medicaid

·         Hospital Charity Care

·         State/County/Parish Indigent Coverage

·         QMB/SLMB

·         SSI/SSDI Disability

·         Children’s Health Initiative Programs (CHIP)

·         State Children’s Health Insurance Programs (SCHIP)

·         Chronically Ill & Disabled Children (CIDC)

·         Veteran’s Administration

·         Cervical and Breast Cancer Programs

·         International Payment on Foreign Nationals

·         Vocational Rehabilitation

·         COBRA

·         Third Party Liability

·         Federal Crime Victims Compensation/Victims of Violent Crime

·         Miscellaneous Private Policies

·         Indian Health Services

·         Long Term Care/Nursing Home Placement

·         Internal Charity

·         Add Baby Account

·         And many more.

By automating the screening process, hospitals can quickly identity individuals who qualify for charity care or other programs 87 percent of the time, with patients incorrectly qualified less than 1 percent of the time. This level of accuracy is unmatched by today’s manual processes.

Today’s registrars can be equipped to perform the following tasks with the proper technology:

·         Identify program candidates at point of registration (or pre-registration). Accounts can be flagged in the HIS screens to identify those patients who are likely candidates for various types of financial assistance while they are registering. This information would enable the registrar to immediately validate a patient’s demographic information and alert a financial counselor.

·         Verify a patient’s income, household size and assets. By accessing trusted third party data sources, hospitals can validate the financial background of the patient to more accurately predict whether or not they will qualify for a financial assistance program. This information is also readily available to the financial counselors to use in the enrollment process (often it can be automatically populated into the forms by the same technology).

·         Easy to use screening wizards determines program eligibility. Online screens can prompt financial counselors to enter any additional patient information to maximize their time during patient interviews. This data is used to ascertain a patient’s eligibility for particular financial assistance program immediately. By relying on technology to manage the complex rules of each program, the financial counselor can reduce their time with each patient and deliver improved options for them.

·         Pre-populated program applications. Patients no longer need to complete long qualification forms in the hopes of securing financial assistance. Instead, the automated system can pre-populate most enrollment forms using patient information in HIS and the financial information received by a third party. Within minutes, the form is completed and needs only the patient’s signature. The entire process can be performed at the initial meeting, eliminating the need for follow-up meetings as well as reassuring the patient that their financial needs will be met.

As today’s economy continues to challenge our healthcare system’s delivery and financial systems, hospitals are finding that automating this step in the process is reaping rewards. Often using the same number of financial staff, hospitals can secure more financial assistance to improve their bottom line.

“Technology enabled us to automate how we identify self-pay patients and screen for eligibility for our charity program,” said Linda Krish, Director of Revenue Cycle at Mercy. “Today, we have improved the quality of our data for self pay patients which resulted in increased collections and improved accuracy of our charity care applications. Today’s easy-to-use solutions allowed us to take a paper intensive process and change it to a streamlined one. Our financial counselors love the solution and the time that it saves them.”

Answers are available. Just ask the hospitals that have automated and thereby helped more than five million patients receive financial assistance available to them.  

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