Verification is 'huge' with Affordable Care Act

Like many patient access leaders, Linaka Kain, DE, a disability examiner and Medicaid specialist at Trinity Regional Health System — Rock Island, IL, is expecting a large influx of "newly eligible" patients coming on to the Medicaid program as a result of the Affordable Care Act (ACA) in 2014.

Kain says one process in particular will become particularly important for all patient access departments. "The verification piece is going to be huge," she predicts. "Everybody is going to need to have the means to verify coverage online and to have it give them an accurate verification."

Kain expects that the quicker Medicaid application process itself will encourage many people to seek coverage. "The average application in Illinois is now 16 pages, and that will be down to three pages. There will be a single-page form for a single person," she says.

Members of the patient access staff already field many questions from patients about coverage choices, such as, "Should I choose the regular Medicaid plan through the state, or an HMO Medicaid plan?" "You cannot tell them which one to pick," says Kain. The reason is that each patient’s situation is different, and patient access employees lack the necessary training to give this type of advice, she explains.

Similarly, patients on disability often ask patient access employees how much they will receive. "If you don’t know what you’re doing, you could misquote someone," warns Kain. "You may tell them they will get $2,000 a month and $10,000 in back pay, and when they actually get their determination letter, it isn’t that."

Patient access leaders need to plan now for how they’re going to handle the influx of questions about coverage that will come soon, urges Kain. "You need to determine how the flow is going to be," she says. "Are you going to have someone stationed in the immediate area to answer questions?"

While Trinity’s patient access employees can answer some basic questions about coverage options, they’ll direct patients with more complex Medicaid or insurance questions to Kain.

"You don’t want the people upfront to give incorrect or inaccurate information to patients," she says.