Give staff ability to help with coverage

Make it a top priority

“Ensuring all patients have access to affordable health insurance is one of our top priorities,” says Irma Becker, manager of patient access at Phoenix (AZ) Children’s Hospital/Phoenix Children’s Medical Group.

Nine full-time employees assist families with the Medicaid application process, including five financial counselors assigned to inpatients, three assigned to the physician group, one based in the emergency department, and one assigned to the pre-access group.

“In our experience, 50% to 60% of our patients are Medicaid-eligible. This number has dropped a little in the last few years due to Medicaid program changes,” says Becker.

Counselors are available seven days a week, and they are supported by a vendor when follow-up is required post-discharge. For families that are not eligible for Medicaid, the financial counseling team provides assistance with private insurance applications, other government assistance programs, and the hospital’s financial assistance program. “We continuously evaluate our processes and procedures to ensure we are providing the best service to our patients and their families,” says Becker. “The Affordable Health Care Act will take full effect in 2014. We have begun preparing for these changes so we are ready.”

Expanded role

Patient access staff at Cadence Health in Winfield, IL, are becoming more involved with communicating the patient’s financial responsibility and, in some cases, the collection of that patient’s financial responsibility, whether it is a deductible, down payment, or co-insurance, reports Debbie Milke-Wurster, RHIT, revenue cycle manager.

“Flexibility is essential,” she says. “Additionally, productivity is a factor that is being monitored more closely. This will allow us to determine if additional counselors are needed to expand collections to additional areas in the future.”

Productivity is monitored electronically and manually, based on the task being performed. “For example, accounts for collection prior to the procedure are measured electronically through a work queue,” says Milke-Wurster. “We are working toward monitoring our financial assistance applications electronically in the upcoming year.”

Milke-Wurster says patient access is evolving into a combined financial counselor and registration role. “Staff will need more knowledge on benefits, eligibility, collection of money, and what registration elements are required for a clean bill,” she says.

To address this change, the department’s registration educator conducts classes and one-on-one training. “We also find it helpful for staff to learn how their job responsibilities affect other areas,” says Milke-Wurster. “I invite leadership from ancillary departments to speak at our monthly department meetings on topics that intertwine with our scope of work.”

Milke-Wurster says that she uses scripting to help staff master new financial counseling skills. “The registration staff needs to be comfortable with discussing finances with the patient,” she says. “Not all are, and the patient can sense that.”

Registrars use this scripting: “Hello, this is _____________, financial counselor from Cadence Health. I am calling in regard to your upcoming procedure on ________________. I have contacted your insurance company to confirm your eligibility and obtain your benefit information. Currently, you still have _______ remaining with your deductible. We would like to collect a down payment toward your deductible. We can either take a credit card payment over the phone or meet you at the time of service to collect.”

“We are currently working on scripting for collections on patients that do not have insurance,” says Milke-Wurster. “Providing the patients with information on their financial responsibility ahead of time allows for them to make an educated decision.” (See related story on one department’s process to identify a payer source for self-pay patients.)

Sources

For more information on helping patients obtain insurance coverage, contact:

Irma Becker, Manager, Patient Access, Phoenix (AZ) Children’s Hospital/Phoenix Children’s Medical Group. Phone: (602) 933-1911. Fax: (602) 933-1138. Email: ibecker@phoenixchildrens.com.

Debbie Milke-Wurster, RHIT, Revenue Cycle Manager, Cadence Health, Winfield, IL. Phone: (630) 933-3038. Fax: (630) 933-2628. E-mail: Debbie.Milke-Wurster@CadenceHealth.org.

Robb Wilburn, CHAM, MBA, Director, Patient Registration, Sarasota (FL) Memorial Health Care System. Phone: (941) 917-2366. Fax: (941) 917- 1134. Email: robb-wilburn@smh.com.