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Patient access and clinical units work together to financially and clinically clear transfer patients at UCSF Medical Center.
Patient access leaders at Chicago-based Presence Health have received “fewer and fewer” complaints from patients regarding the balance that they owe, reports La’Queela Angel, director of patient payments. One reason is that the hospital’s Financial Assistance Committee routinely reviews accounts that didn’t initially meet criteria for charity, to see if they qualify for an exception.
The hospital’s policy states that patients with insurance don’t qualify for charity unless they have an income that is 200% or below the federal poverty level (FPL). In some cases, Angel brings an account to the hospital’s financial services committee and asks them to override the policy.
“We make the case for the patient,” says Angel. “In some cases, they will approve it, and the patient qualifies for something less than 100% charity.”
Patients are more satisfied because they don’t receive a bill and because they receive assistance with their healthcare insurance needs. “They appreciate not having to go to the Medicaid office to complete an application,” says Angel. “We in financial counseling can do that piece for them.”
Charity is decreasing for Presence Health’s self-pay patients, because many now qualify for some type of insurance under the Health Insurance Marketplace or for Medicaid. However, says Angel, “many of our self-pays who now have insurance still can’t afford their coinsurance or deductibles.”
Presence Health changed its processes to ensure that patients are screened for presumptive charity prior to being billed. “We run accounts through our eligibility systems to validate if the patient has any presumptive charity category,” says Angel.
Financial counselors also do healthcare credit scoring to determine if the patient’s income is at or under 200% of the FPL. If so, the patient qualifies for presumptive charity. “Instead of billing the patients, or having them fill out a complete financial assistance application, we know right away that they qualify,” Angel says.
Before an account is sent to bad debt, one last check is done to be sure the patient’s situation hasn’t changed during the 120 days the account stays in accounts receivable. “You do have some patients that don’t qualify initially, but later qualify because something has changed since they initially became a patient,” Angel says.
If a patient didn’t initially qualify for charity, he or she will start to receive statements. “But before they go to bad debt, we complete one last presumptive charity check for the patient account,” says Angel.
If the result returns an account with a favorable FPL, the account is processed for presumptive charity, and the patient’s bill never goes to bad debt.
“To hear the account has been adjusted to financial assistance makes the patient a very satisfied customer,” says Angel.
A strong financial counseling process already was in place when patient access started point-of-service collections at OSF Saint Anthony Medical Center in Rockford, IL.
Nicole Fountain, CRCE-I, CHAM, revenue cycle director, says, “We knew very well that we had a safety net in place for people who couldn’t afford to pay.”
Fountain gets far more complaints about the billing process than the pre-service process. “Patients are much more disgruntled when they get a bill they don’t expect than when you provide them information in advance, even when it’s not good news,” she explains.
Even if out-of-pocket costs come as a shock to patients, members of the staff are there to explain what options are available. “You are right there to help them through it,” says Fountain. “That conversation can make a big difference to someone’s life.”
In some cases, patients are relieved to get enrolled with coverage for future healthcare needs. “It is really critical that you approach point-of-service collections as an advocate,” Fountain emphasizes. (See related story in this month’s issue on how to educate clinicians on collections.)