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Is your self-pay patient eligible for charity or not?
You might uncover insurance
As self-pay patients continue to rise in number, you'll need effective strategies for screening these individuals for charity eligibility.
"You have to do a good job of screening to see if they have coverage or eligibility under a governmental program," says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services at Apollo Health Street, a Bloomfield, NJ-based developer of financial and IT solutions for healthcare organizations, a Bloomfield, NJ-based consulting company working with healthcare organizations, and author of Staff Competency in Patient Access. "To me, that's all part of a good process and doing a good job."
Friedberg says that all self-pay patients should "immediately be screened against your state's Medicaid program. If there are any patients that are over 65 with a social security number that you are not checking for Medicare, shame on you."
Friedberg says that when time permits, checking the system for existing prior visits paid by insurance is another technique that can be effective. "In many instances, patients will have multiple medical records within a provider's system," he explains. "Depending on the accuracy of the registrar, one record could be registered with self-pay and another with insurance."
Likewise, says Friedberg, a correction might be made after registration because a patient was discovered to have insurance, but the registrar might not pick up the correct patient.
Time is limitation
"Unfortunately, in patient access, there isn't always time for this," says Friedberg. "You have to make sure that you keep things moving, but you can also uncover insurance."
He recommends meeting with your patient accounting team and asking if they are finding insurance or Medicaid coverage on self-pay patients.
There always will be cases when a staff member discovers a patient's insurance later in the process, due to the lack of consistency of carrier database updates, says Friedberg. "But what constitutes too much? That is the hard part," he says. "If you have a vendor that is doing this work, look at the accounts where the vendor is uncovering insurance, because that's a direct reflection of how well you are doing."
If you learn that "too much" insurance is being found, you should analyze two primary items, says Friedberg. First, he says, look at sample accounts to determine what type of insurance is being uncovered and also in what area and on what shift. Secondly, Friedberg advises reinforcing procedures to be sure that a proper interview is being performed at the time of registration.
"In many instances, errors made in the registration process point back to a poorly done interview," says Friedberg. "A focus on the interview process will yield improvement."
For more information, contact:
Michael S. Friedberg, FACHE, CHAM, Associate Vice President, Patient Access Services, Apollo Health Street, Bloomfield, NJ. Phone: (973) 233-7644. E-mail: firstname.lastname@example.org.