Don’t let patients’ financial worries make access into the adversary

New role for registrars presents opportunity: Offer them help

If you’re the one who tells self-pay patients their bill is in the six figures without offering any assistance, they’re very likely to “blame the messenger” and become defensive. On the other hand, what if you could give those patients peace of mind by helping them obtain desperately needed coverage?

“When registrars present the estimate to the patient, it can be quite a surprise,” says Kym Brown, BA, CHAM, manager of patient access at Saint Elizabeth Regional Medical Center in Lincoln, NE. “Patients may be upset about their estimated amount, that we asked for payment, or just due to the stress of their situation.”

Registrars go out of their way to explain the estimate, involve financial counselors on the spot, and offer information on setting up payment arrangements or filing applications for financial assistance. “Patients are generally relieved at these extra efforts from staff,” says Brown. “Registrars are sometimes the first person to hear about the patient’s financial struggles.”

Patient access is usually the first contact a patient or family member has when they come into the hospital and the first opportunity to collect the patient’s out-of-pocket responsibility, says Mitch Mitchell, president of T.T. Mitchell Consulting, a Liverpool, NY-based consulting firm specializing in revenue cycle and technology. “Customer service is paramount. But hospitals deserve to get paid, just like any other entity,” he says.

At Trinity Rock Island (IL) 15% to 20% of patients are self-pay, and the hospital collects about $150,000 a month of additional revenue by identifying Medicaid-eligible patients, says Linaka Kain, the hospital’s disability examiner/Medicaid specialist. “We have been able to convert roughly 16% to Medicaid and the rest to charity,” Kain reports. “We increased our amount of Social Security disability/Medicaid approvals by 15% last year. These patients were initially self-pay.”

Know all options

The hospital is seeing a spike in self-pay patients between the age of 60 and 64, says Kain. “There is a huge hole there. They aren’t old enough for Medicare, are either working a part-time job or not working, and they are not insured,” she adds.

The challenge is to figure out how to help a patient in this group, who is going to be placed in a long-term setting for rehabilitation, obtain coverage, she says. “A lot of nursing homes won’t take self-pays if they are not in a pending status for Medicaid,” Kain explains. “We can’t have them in the hospital for months on end, because they don’t meet the criteria.”

Most patients in this situation apply for financial assistance from the hospital. “When it comes to financial assistance and what programs are available, we have to stay a step ahead,” Kain underscores. For example, Iowa won’t process any paperwork for Medicaid if the patient isn’t already on Social Security disability, whereas the state of Illinois will begin processing the application if proof of filing is provided.

“Knowing that makes a huge difference in whether a patient will end up being eligible,” says Kain. “If we are not on top of what is going on out there, we will end up with a ton of charity write-offs.”

As a not-for-profit hospital, the charity program is always used as a last resort of payment, she explains. “It is far better for our patients and the hospital to advocate for them and get them eligibility in a funding source if we can,” Kain says.

“Two-way street”

Some patients start out insisting that the hospital simply write off the entire amount of their bill, says Kain. In this case, patient access staff members educate them about the patient’s role in the process.

“Some people think they should have everything for free. We explain to them that it’s a pot of money and a lot of people are dipping into the pot, so we just can’t write everything off for someone,” she says. “The patient has to participate. It’s a two-way street.”

The patient has to sign paperwork and might have to go to the Medicaid office after being discharged, for example. In many cases, though, applications for Social Security Disability, Medicaid, or both, are filed before the patient is discharged. “Sometimes I get an answer on both before the patient even goes home, which is a godsend for them,” says Kain. “It’s another thing they don’t have to worry about.”

After her first meeting with an inpatient, Kain checks in a day or two later if the patient is still in the hospital to see if anything has changed. “The patient may come in with one illness, but after a day or two goes by, you realize everything has changed drastically,” she says. The patients might have been diagnosed with a condition that requires long-term care, for example, which makes them eligible for a certain type of coverage.

“Some people think it’s not a good idea to tell people how much their bill is, but I disagree,” says Kain. “People need to understand how expensive things are, because they have no idea. Patients think open heart surgery and rehabilitation costs around $10,000, but it’s over $150,000.”

Once Kain completes a patient’s application, she explains that Medicaid is being asked to cover services retroactively, and then she tells the patient not to open the bills they receive in the mail. “I tell them, ‘Just put them in a stack — don’t stress yourself out. We will need to give them to the Medicaid office, but we will deal with that when the time comes,’” says Kain.


For more information on helping patients obtain coverage, contact:

Kym Brown, CHAM, Manager, Patient Access, Conifer Health Solutions/CHI, Saint Elizabeth Regional Medical Center, Lincoln, NE. Phone: (402) 219-7316. Fax: (402) 219-7199. Email:

Linaka Kain, Disability Examiner/Medicaid Specialist, Trinity Rock Island (IL). Phone: (309) 779-2648. Email:

T.T. “Mitch” Mitchell, President, T.T. Mitchell Consulting, Liverpool, NY. Phone: (315) 622-5922. Email: