$550,000 of self-pays converted in one month

Offer eligibility assistance to patients

In a single month, registrars at Trinity Regional Health System in Rock Island, IL, were able to obtain disability coverage for five patients with a total of $450,000 in charges, and they were able to obtain Medicaid coverage for 104 patients who had received a total of $100,000 in services.

All of these patients initially came into the hospital's emergency department (ED) as self-pay, says Nikki Mahieu, manager of registration services, and their account balances likely would have gone to collection.

In some cases, well-meaning family members might help you to register an ill ED patient, but they offer inaccurate or outdated demographic information. You also might get bad information from patients with language barriers or those under the influence of drugs or alcohol, says Mahieu.

Accurate information gives registrars the ability to offer ED patients coverage options they don't realize are available to them, says Mahieu. "We will screen them for any sort of hidden potential coverage," she says. "Many ED patients are potential Medicaid patients."

If patients are receiving limited assistance from the state, they often qualify for full Medicaid coverage, depending on their diagnosis, says Mahieu. Registrars ask injured patients if they were hurt at home or in a car accident, she says, to determine if liability insurance will cover the ED visit.

If patients are eligible for COBRA coverage but can't afford the back premiums, it might be worthwhile for the hospital to pay these in order for the services to be covered, adds Mahieu. "You have to build a really tight process on screening every self pay patient — not just for Medicaid, but also everything else," says Mahieu. "There are a lot of things we can do upfront to make sure we get the best information possible."

Convert from self-pay

Trinity Regional's ED financial advocates routinely ask self-pay patients key questions and refer them to a Medicaid specialist if there are any "yes" responses, says Mahieu.

"We've got people going to the floors to get additional information from ED patients who become inpatients," Mahieu says. "If an application is incomplete or contains errors, a lead [financial advocate] goes back to review it with the advocate."

Recently, Mahieu consulted with a self-pay patient who was receiving an EKG about the possibility of obtaining Medicaid coverage. "I explained that she was better off getting some sort of coverage, than going out as self-pay where it may end up going to collection," she says. "She was very positive and forthcoming, and didn't hide any information."

This reaction is typical, in part due to scripting used by registrars that emphasizes patients can only benefit from the process, says Mahieu.

If self-pay patients do obtain coverage, this saves the hospital's charity funds for those who really need them, adds Mahieu. "Charity is there as a last resort," she says. "If we can keep that available for people who are never going to qualify for Medicaid or another form of coverage, that's the best case scenario."