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Those 'sharing' coverage might qualify for help
Have staff offer financial assistance
Occasionally, individuals pose as others to "share" insurance coverage with family members or friends, reports Jane Gray, CPA, FACHE, FHFMA, assistant vice president for the revenue cycle at the Medical Center of Central Georgia in Macon. In one such case, the medical records of a woman who delivered a full-term baby showed she had a full term delivery just three months earlier.
"She had assumed her sister's identity," explains Gray. "We have a lot of that. People also try to share eligibility under our financial assistance program, in order to avoid paying for healthcare."
This situation happens most often in the emergency department, says Gray, due to Emergency Medical Treatment and Labor Act (EMTALA) requirements. "People are in tune with that. They know what the EMTALA laws are, and that they have a right to receive care regardless of their ability to pay," says Gray. "They are often less forthcoming in that environment."
Some of these individuals, says Gray, might be surprised to learn they are eligible for financial assistance. Gray notes that a patient making $100,000 a year could have a million dollar medical bill and quality for financial assistance. "At some point, almost everybody needs assistance," she says. "I don't know if that idea has permeated society yet, but assistance is out there for more people than you would think."
Staff now look for verbal cues that might indicate a patient's inability to pay and refer these patients to the hospital's financial assistance program, says Gray. "In the course of a conversation with a patient, they might say something that would prompt you to ask them if they would like to speak with someone about qualifying for assistance," she says.
The assistance program assesses uninsured individuals to see if they qualify for Medicaid or other programs, says Gray. "Some people know the system and work it to death. Other people don't even realize that they could qualify and are thrilled to death to get assistance," she says.
When patients utilize one of the hospital's registration kiosks, says Gray, they are asked for their date of birth and last four digits of their Social Security number. "So you get some element of protection there," says Gray. "As the patient enters payment information, there is some degree of identity validation in making sure names match and so forth."
For more information on financial assistance programs and fraud prevention, contact:
Jane Gray, CPA, FACHE, FHFMA, Assistant Vice President, Revenue Cycle, Medical Center of Central Georgia, Macon. Phone: (478) 633-2097. Fax: (478) 633-4071. E-mail: Gray.Jane@mccg.org.