Finances are a top priority for access
Unfortunately, healthcare costs are often the first thing that comes to mind when someone gets sick, says Elizabeth H. Broadway, CHAM, director of patient access and business services at Ochsner Health Systems Baton Rouge (LA) Region.
"We can counsel patients on the costs and financial expectations during the pre-registration call, but the resources are limited for the population that is underinsured," she says.
This issue results in increased cancellations at the point-of-service and high levels of frustration for the patient, due to a lack of other financial options, she reports. "Louisiana is one of the only states left that has an 'organized' charity care system," says Broadway. "Unfortunately, this is where the patients have traditionally ended up."
For these reasons, patient access staff members have made financial counseling a top priority. "This has become a staple item of our healthcare system," reports Broadway. "We advocate that the patient must be given the opportunity to make a detailed and informed decision regarding the financial aspect of their healthcare."
Patient access representatives take these steps:
• They sit with the patients in a private, confidential area to discuss what their needs are and what resources are available. This meeting occurs prior to their scheduled visits or at the day of their scheduled encounters.
• They explain the patients' current coverage and educate them on how the benefits will work.
Staff members begin by stating what the benefits are and then ask the patients if they are aware of the limited coverage provided by the plan.
"From there, we identify what the financial gaps are. We help cover these gaps with any assistance or resources that are available," says Broadway.
• Once the patients express that they would like more details on what to expect from a financial standpoint, staff members escort the patients to an available financial counselor.
Fewer no-shows
Broadway says that obtaining accurate, verified data for all patient demographics is one way to prevent lost revenue.
"We are then able to seamlessly determine the eligibility and benefits of a payer and establish what the anticipated financial requirements of the patient will be," she says.
Each patient must be financially cleared for services performed in a non-emergent, elective environment. "Performing this service ahead of the appointment date reduces the number of no-shows. It allows the cancellations to be filled ahead of time," says Broadway.
Patient access employees recently met with a woman who had a limited benefit plan and whose husband's job was reduced from a full-time to a part-time position. "They lost the benefits associated with his full-time employment. The wife exhausted all their COBRA benefits," says Broadway.
The patient began coming for services and soon realized that she was paying too much money for too little coverage. Staff referred her and her husband for qualification under a state-assisted HIPAA pool coverage plan.
"She has to pay a little more each month for the premium," says Broadway. "But she has comprehensive coverage for herself and her husband with much less out-of-pocket and much more peace of mind."
