Goal is to identify payer source for self-pay

It’s crucial to reimbursement

Your patient access employees probably are accustomed to fielding questions from patients about insurance coverage, but what about helping uninsured patients obtain coverage?

This skill is becoming become important due to the implementation of the Patient Protection and Affordable Care Act, advises Robb Wilburn, CHAM, MBA, director of patient registration at Sarasota (FL) Memorial Health Care System.

“All healthcare facilities will have to do a better job identifying patients who may be eligible for Medicaid. It will be crucial to reimbursement,” he says. Patients who qualified for the hospital’s charity program might become eligible for Medicaid as of 2014, notes Wilburn.

“Our process is to find a payer source. If there is none, can the patient pay? If not, we screen for Medicaid and then charity as a last resort,” says Wilburn, adding that Medicaid comprises about 8% to 10% of the hospital’s total revenue. The department’s current process is the following:

• Registrars perform a check on all self-pay patients to see if they have existing Medicaid coverage.

“If they do not have Medicaid, and they are a true self-pay, we screen the patient to see if they may qualify for Medicaid or another government program.” says Wilburn.

• Registrars screen all emergency department patients after they are seen by a physician, and the patient is assigned a caseworker to complete the application process.

• On the inpatient/outpatient side, patients are screened before presenting at the hospital or shortly after their visit.

• An in-house Medicaid program screens patients for eligibility, and vendors are used for difficult cases and disability cases.

“About a quarter of patients presenting to patient access employees as self-pay are actually eligible for Medicaid, not including disability patients,” says Wilburn.