Stop Denied Claims for Patients Discharged With Complex Needs
Some hospitalized patients have complex discharge needs. While many of these needs are clinical, patient access can help with coverage issues.
Communication between patient access and clinical areas “is so very important” when dealing with complex discharge issues, says Kylie Sokol, supervisor for hospital admitting services and financial counseling at The Ohio State University Wexner Medical Center.
Clinical and financial counseling teams update each other on possible delays or barriers to discharging patients. For instance, staff sometimes are unable to communicate with the patient because of a medical condition or lack of decision-making capacity. In such cases, says Sokol, “we work closely with the social workers to help in communication with the patient’s legal next of kin or family.” Sokol personally meets with all newly hired clinical case managers and social workers as part of their onboarding. This ensures that they all understand the financial counselor’s role. All available Medicaid programs also are reviewed. Financial counselors are assigned to particular hospital services. “Each clinical team has a dedicated contact for financial questions on behalf of the patient,” Sokol notes.
This automatically includes all self-pays who are admitted. “But if an insured patient or a patient’s family has brought up questions about their bill or potential out-of-pocket costs, we can see them as well,” Sokol adds.
Patient access managers serve on a hospital committee focused on patients with complicated medical needs. Also represented are legal, ethics, hospital administration, and clinicians. Working collaboratively with this group “has created openness and trust,” Sokol reports.
The biggest obstacle in discharge planning is lack of insurance. “Sometimes, patients cannot provide information about themselves to us,” Sokol says, perhaps because of a medical condition or recent brain injury. “If the family is estranged or unwilling to help, we discuss these patients in committee,” Sokol says.
The group determines if the patient needs a court-appointed guardian to help with obtaining Medicaid verifications. These patients often experience complex discharges and need follow-up care. “Patient access can help the team understand potential delays in obtaining coverages for discharge planning,” Sokol notes.
In Ohio, patients have to be resource- and income-eligible for Medicaid. Helping patients exhaust resources on allowable items can be challenging.
“Patient access keeps the committee up to date on the progress, or lack of progress,” Sokol says.
Some hospitalized patients have complex discharge needs. While many of these needs are clinical, patient access can help with coverage issues.
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