New coordinator focuses on difficult accounts

Provides extra hand-holding for self-pay patients

Memorial Hospital in Colorado Springs, CO, has boosted its reimbursement for patient care by more than $300,000 since it added a new patient benefits coordinator to the admission services staff about a year ago.

As the sole city hospital in a community of 450,000, Memorial handles a large proportion of self-pay and/or hard-to-collect accounts, many of them belonging to patients in rural communities in the southern part of the state, says Rebecca Chance-Smith, manager of admission services. Those patients, many of whom require specialized care, need extra "hand-holding" during the process of obtaining financial coverage, she adds.

Until last August, the hospital was relieving its financial counselors of the burden of those problematic accounts by contracting with an outside company to handle them.

With three financial counselors doing preauthorizations on inpatient accounts, verifying benefits, and making arrangements with patients about inpatient bills, there was no time left to provide the extra help some patients needed to become qualified for Medicaid or Supplemental Social Security assistance, Smith explains.

"We contracted with a company, paid them 26% of what they collected - later they lowered that because we gave them so much business - and if they were not able to get Medicaid on the account, we wouldn't pay them anything," she says. "They came down at least once a week from Denver to pick up the referrals."

The new position came about because of several concerns with the outsourcing arrangement, Smith notes. "We started seeing how much money we were paying them, and also the patient and family services department felt the company didn't look at the whole picture."

In some cases, there might be a problem, something serious that was causing the patient or family not to proceed with the process of obtaining benefits, Smith adds. Also, because the company is not local, it couldn't always respond quickly to a situation, she says.

Along with the managers of patient and family services and patient financial services, she proposed that the hospital handle the difficult accounts internally, hiring a person who could look at both the financial and the social needs of the patient and his or her family. After receiving approval for the new position, she found a uniquely qualified applicant - a master's candidate in social work serving an internship at the hospital - who ultimately was selected for the job.

Scott Rucker, the candidate selected, was bilingual, a big plus in working with the hospital's Hispanic patients. He also had experience working with adults with developmental disabilities. That experience means Rucker is familiar with the financial assistance resources available to people with disabilities and has contacts in the assistance community, Smith points out.

Those connections are particularly appealing, because the outsourcing company had never really developed a relationship with local Department of Human Services (DHS) staff, Smith adds.

Although the effort to obtain benefits mostly involved Medicaid, she explains, the hospital also was interested in helping patients qualify for veterans' benefits or the Colorado Indigent Care Program. More money to meet the patients' basic needs might mean an increased ability to be able to make some kind of payment to the hospital.

Counselors still screen

Even with the patient benefits coordinator in place, the hospital's financial counselors continue to screen all patients, and if those needing assistance appear ready and able to apply for it on their own, the coordinator isn't brought in, she says. (For more on the benefits coordinator function, see story, at right.)

"But if the financial counselor, the social worker, the nurse on the floor, or the physician feels the patient may not physically, mentally, or socially be able to follow up," the patient benefits coordinator gets the referral, Smith notes.

In some cases, she points out, he simply serves as a kind of back-up authority figure, reinforcing to an uncooperative patient the importance of applying for benefits. "Sometimes [the patients] just need to hear it from somebody else, and then all of sudden they say,'Maybe they are trying to help me, and are not just after the money.'"

The benefits coordinator files applications on behalf of patients who have transportation problems or are too sick to go themselves. "He will go to the Social Security office, sit and wait for papers. Patients have really, really liked that. Also, these [assistance personnel] get to put a name with a face, and they are very appreciative. They get to know him."

An earlier effort to have a DHS worker on-site at the hospital failed, she notes, because the government agency didn't have the staff to continue the service. "That really put [the burden] back on the hospital," Smith adds.

With his experience in the assistance arena, the benefits coordinator often can determine upfront that a patient will never cooperate in trying to get benefits or that the patient won't qualify for help, she says. "He gives us a heads-up that keeps us from going through the whole process and finding out they're over [the] income [cap] anyway."

Between August 1997, when the position began, and the end of May 1998, the benefits coordinator was given 141 referrals, representing $8,726,000 in charges, she says. Of those accounts, he has been able to get 78 patients on Medicaid so far, with actual reimbursement of $1.3 million, and 16 patients in the Colorado Indigent Care Program, with reimbursement of about $120,000.

Thirty-one of the accounts are pending Medicaid approval, six received help from other payment sources, and 10 patients either were uncooperative or didn't qualify, she adds. Of those 10, some were given internal assistance or bank financing, and others were classified as bad debt.

"Saving 26% of that dollar amount is certainly a benefit to the hospital, but it's also a great community service. We're trying to take the patient's wellness into consideration," Smith points out.

The program benefits the hospital and the patient, agrees Rucker. "A lot of times people worry about paying their bill, and that gets in the way of treatment. If we can help them have continuity of care inside the hospital and out of it, we can keep them from using the hospital as their only medical resource."

"It gives the hospital a human face on the financial side," he adds, "and it's a fun job for me."