Is self-pay patient eligible? Find out in real time, or close to it
If a self-pay or underinsured patient presents to you for services, how quickly can you determine if he or she is eligible for Medicaid or another public program?
"Anything that facilitates early benefit determination will help improve cash and decrease cost," says Gerilynn Sevenikar, vice president of patient financial services for Sharp Healthcare in San Diego. "Both are positive outcomes in managing the revenue cycle."
Sharp's registrars first use a real-time eligibility program to determine if a patient has current coverage. "It goes to the payer web site, grabs the eligibility and benefit information, and populates our insurance verification screen accordingly," she says.
If no private insurance eligibility is found, registrars click on a hyperlink to a questionnaire on the patient registration screen. (To access the questionnaire, created by the non-profit Foundation for Health Coverage Education, go to www.CoverageForAll.org and select "Health Coverage Eligibility Quiz.")
"When completing the screening questions, a customized matrix is produced for the patient, complete with additional information on our local funding options," says Sevenikar.
This information is then fed back to the Sharp registration system, she says, and registrars document the patient's income, family size, and funding options that were shared with the patient. "Over the short term, I expect collecting this basic information on all unfunded and underfunded patients will allow Sharp to perfect the patient conversation around account resolution," says Sevenikar.
Registrars complete the application process for program funding or discuss the patient's ability to pay either way, the account can be resolved, she explains. "Our approach is that of an advocate or navigator in determining the direction for resolving the debt, in a way that makes sense to the patient and is reasonable," Sevenikar says.
Ankeny Minoux, president of the Foundation for Health Coverage Education, expects more hospital emergency departments to integrate the Health Coverage Eligibility quiz into their registration processes, as Sharp Hospitals are doing. "From this integration, Sharp has been able to help more than 24,000 self-pay patients determine their eligibility for a variety of health coverage options," she adds.
Since reimbursements from public programs are retroactive, use of the eligibility quiz at point-of-care significantly increases self-pay revenue for hospitals, adds Minoux. "This changes the landscape for hospitals to more successfully negotiate with the state for Medicaid reimbursements. It identifies private payers, such as those patients eligible for COBRA, within the 60-day window," she says.
Sevenikar says that ideally, a patient could present for services and become instantly eligible for Medicaid. "We could do it today if states could agree on what sources should be accessed electronically to verify income, expenses, citizenship, and assets," she says. "Once that hurdle can be overcome, enrollment could happen at point of care, once a proper identification is secured."
Sources
For more information about processes for eligibility determination, contact:
Ankeny Minoux, Foundation for Health Coverage Education. Phone: (650) 762-1794. E-mail: [email protected].
Gerilynn Sevenikar, Patient Financial Services, Sharp HealthCare, San Diego. Phone: (858) 499-4215. Fax: (858) 499-4315. E-mail: [email protected].
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