Half of self-pay patients found Medicaid-eligible

At Vanderbilt, counselors assist each one

About half of the self-pay patients presenting for services at Vanderbilt University Hospital in Nashville ultimately obtain Medicaid coverage, reports Marsha Kedigh, RN, MSM, director of admitting/emergency department registration/discharge station/insurance management.

"Financial counselors follow every self-pay admission," says Kedigh, adding that 8.2% of the hospital's total discharges are self-pay. "Their process is to verify if the patient truly is self-pay or has coverage."

The counselors assist self-pay patients with submitting applications for Medicaid, Supplemental Security Income (SSI), or disability coverage, which are approved, denied, pending, or non-compliant, meaning the patient didn't apply or didn't follow through with the application process. "This is a long process," says Kedigh.

Members of the patient access staff at University of Iowa Hospitals and Clinics in Iowa City are seeing many more patients with coinsurances without maximums, and larger co-pays and deductibles, reports Sherri Pitkin, associate director of patient access management. "From the previous average of $2,500, it is more common to see $6,500," she reports.

Staff members are seeing many more patients with COBRA coverage, adds Pitkin, and the hospital often pays premiums for patients that qualify financially for assistance. The only reason the hospital hasn't seen a large growth in self-pay patients is because many individuals are now covered by IowaCare, a limited healthcare program for adults who normally would not be covered by traditional Medicaid, according to Pitkin.

Although the department does ensure that Medicaid covers all appropriate past visits, this happens usually if SSI or Social Security Disability Insurance coverage also is involved. "We are very efficient at finding traditional Medicaid and IowaCare coverage before services are rendered," says Pitkin. This determination occurs shortly after medical triage unless it's an emergency situation, says Pitkin, and it happens while admitted patients still are in the hospital.

"Our financial counselors and our [Health Care Benefits Assistance Program] social workers assist in filling out Medicaid applications for approximately 85% of our patients that are initially self-pay," says Pitkin.