Employers and insurers are “pushing more of the burden of healthcare expenses onto patients,” says Stacy Calvaruso, CHAM, system director of patient access at LCMC Health in New Orleans. “Unfortunately, this is having a negative impact on the healthcare community.”
Hospitals are increasingly depending on patient access to identify patients who don’t have adequate health insurance coverage and/or have high-deductible plans. “Organizations continue to see an upward trend of patients who are either deferring and/or forego healthcare services,” Calvaruso says.
Financial counseling continues to move to the front end. “The role of patient access is continuing to change,” Calvaruso says. “This is just one more step in the evolution of pushing revenue cycle to the front end.”
At Glenwood Springs, CO-based Valley View Hospital, patient access leaders expanded the hours of financial counselors and added another full-time financial counselor. The department also made changes to the financial brochure given to patients and updated its charity application.
Patient access manager Laura King adds, “We have our financial counselors visiting patients at the bedside in the ER after hours and on weekends.”
Many patient access departments now handle price estimates, presumptive charity, and payment plans. “Organizations feel that with [financial counseling] being a part of the point-of-service collections program at registration, they will meet the requirement to widely publicize their financial assistance plan,” says Calvaruso.
Requiring payment before providing medically necessary care because of nonpayment of prior bills for care covered under the financial assistance policy is considered an extraordinary collection activity, according to recently updated 501(r) rules.
When collecting at the point of service, says Calvaruso, “an organization should have a mechanism to confirm a patient’s qualification of financial assistance at that time.” She says patient access should do the following:
- Maintain an accurate listing of patients who are approved for financial assistance and their specific dates.
- Have a method to quickly validate a patient’s continued qualification for financial assistance.
This validation might entail a medical credit scoring tool, says Calvaruso, or a “rapid review” process if patient access does manual assessments of a patient’s ability to pay. “Without the appropriate tools, patient access team members and financial counselors are unable to prevent non-compliance with the regulations,” warns Calvaruso.
- Review, and update if necessary, the financial assistance policy and application process.
If an organization is not using a presumptive charity tool, says Calvaruso, leaders should confirm that the workflow is closely monitored to ensure consistency with the approval and denial processes.
“A full listing of any and all available resources that a patient may have, as well as an attestation of income sources, is strongly encouraged,” says Calvaruso.
