Executive Summary
Almost half of individuals who were uninsured at the beginning of 2015 are eligible for Medicaid or subsidized coverage, according to a recent analysis. Patient access employees convert 62% of self-pays to coverage at West Valley Medical Center.
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Have an onsite Medicaid vendor convert self-pays.
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Have financial counselors work with scheduled surgical patients prior to arrival.
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Give patient access employees an accurate estimate tool.
[Editor’s Note: We covered the Kaiser Family Foundation’s analysis as breaking news on the website for Hospital Access Management’s publisher (reliasmedia.com.) You can keep up with breaking hospital news on that website and @HospitalReport.]
Converting self-pay patients to some type of coverage is a top priority for Linaka Kain, manager of the Marketplace Exchange and a disability examiner at Unity Point Health System — Rock Island (IL).
“These patients can incur hundreds of thousands of dollars using the emergency department. We should feel obligated to help them,” Kain says. In 2014, the department reduced its self-pay patient population by 37%, which equates to $3.2 million in additional revenue.
Nearly half of the 32.3 million nonelderly people in the United States who didn’t have health insurance at the beginning of this year are eligible for Medicaid or subsidized coverage through an Affordable Care Act (ACA) Marketplace, according to an October 2015 analysis by Kaiser Family Foundation.1 (The analysis can be viewed at http://kaiserf.am/1KcsABF).
Kain isn’t surprised that so many patients haven’t obtained coverage through the Health Insurance Marketplace. “Consumers are leery because they don’t understand,” she says.
If a patient has never had insurance before, he or she is likely to be overwhelmed by the enrollment process, insurance terms, and the different plans available.
“Typically, once these types of consumers get insurance, they don’t know what steps to take in order to use it,” adds Kain.
When Kain assists patient in the enrollment process, she educates them on how to use their insurance, using the Coverage to Care booklets provided by the Centers for Medicare & Medicaid Services. (For more information, go to http://1.usa.gov/1BLK2hK.) “They contain a complete overview of what insurance is and how to use it,” says Kain. “This is a fabulous, easy-reading tool that the consumers love.”
Kain just completed a systemwide initiative that incorporates Medicaid specialists and financial advocates into one role: patient financial coordinators. As certified application counselors, the team members are able to enroll patients in coverage through the Health Insurance Marketplace, as well as Medicaid. “This new role alleviates the patient from having to be referred to more than one employee and provides better patient satisfaction,” says Kain.
One patient financial coordinator provides whatever assistance the patient needs: insurance enrollment, financial counseling, screening for medication assistance programs, and possibly, charity care as an option of last resort.
“It reduces duplication of efforts,” says Kain. “It enables us to go above and beyond for our patients.”
Patients knowledgeable
The largest demographic in the population included in the Kaiser Family Foundation’s analysis are the Millennials, born between 1980 and 2000, says Mary Lee DeCoster, vice president of consulting services for Adreima, a Phoenix-based consulting firm that provides revenue cycle service to hospitals.
“Other than childbirth, the majority in this group are most likely not seeking healthcare services. Therefore, they are not motivated to apply for Medicaid or purchase coverage through the ACA,” she explains.
The Kaiser Family Foundation analysis looked at the entire population, not just those seeking healthcare services. “The tax penalty is not yet equal to the annual cost of insurance premiums, and, therefore, does not yet motivate a healthy 25- to 30-year-old to seek coverage,” she says.
DeCoster is former vice president of revenue cycle at the Mariposa Integrated Health System (MIHS), a public safety net health system where about 28% of patients were self-pay and ineligible for Medicaid. At MIHS, she says, “budgets and staffing were prioritized to identify the uninsured and to find a payer source through a third party, whether that was Medicaid or other potential coverage.”
At the time DeCoster was with MIHS, Medicaid paid approximately 18% of the billed charge; in contrast, only about 2.5% was collected from self-pay patients.
DeCoster says there already has been a “huge shift from the uninsured to the insured” as a result of the ACA and Medicaid expansion in 17 states. “The current population of uninsured will be identified and managed through the application processes as they present for care,” says DeCoster.
DeCoster says that patient access plays “the most critical role” in multiple work flows, including the process of:
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identifying funding for uninsured patients;
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verifying eligibility and benefits for insured patients;
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determining the patient’s out-of-pocket expense;
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requesting upfront payment in advance or at the time of service.
“If a hospital does not adequately budget patient access, they will pay for it at the backend with growing self-pay receivables,” warns DeCoster. “These are more difficult to collect as they age in the business office.”
Under-resourced patient access departments will see increases in accounts receivable days outstanding, a decline in overall patient reimbursement, and lower patient satisfaction scores, says DeCoster.
“Consumers are engaging in growing their knowledge about coverage and cost as their out-of-pocket expense grows,” she says. (See related story on how one department converts most self-pays to coverage, in this issue.)
1. Garfield R, Damico A, Cox C, et al. New estimates of eligibility for ACA coverage among the uninsured. The Henry J. Kaiser Family Foundation; Oct. 13, 2015.
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Mary Lee DeCoster, Vice President, Consulting Services, Adreima, Phoenix. Phone: (602) 636-5600. Fax: (602) 265-3693. Email: [email protected].
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Linaka Kain, Manager of the Marketplace Exchange/Disability Examiner, Unity Point Health System, Rock Island, IL. Phone: (309) 779-2648. Fax: (309) 779-3865. Email: [email protected].
