Self-pay A/R cut by $15 million

Drill down to ID verification flaws

Self-pay accounts receivable (A/R) was reduced by about $15 million annually after the patient access department at Geisinger Health System in Danville, PA, implemented daily eligibility checking of self-pay accounts against Medicare and Medicaid to find instances in which patients had coverage for that particular date of service.

“Doing this daily, versus waiting until after the patient collection process, helped us reduce self-pay A/R,” says Angela Long, associate vice president of administrative services in revenue management.

In some instances, patient access staff had verified that a patient had Medicare coverage, but claims were being denied because some of these patients only had Part A coverage. This problem was discovered as part of the department’s process to examine trends or spikes in claim denials to determine root causes, says Long.

To prevent these mistakes from happening, staff were educated to “drill further down into the eligibility response to determine level of coverage,” she says.

Long works with the IT department to further refine the worklists by comparing the eligibility response with the service that is being scheduled. “In instances where we find a flaw in insurance verification — human or otherwise — we look to further enhance our automated rules/processes to help prevent the issue from occurring,” she says.

Another example involved the department’s rising self-pay A/R. Only after patients were sent multiple statements, and after numerous collection attempts, would registrars learn that they actually had coverage.

“We found pockets of the organization where appointments or services were being scheduled and no insurance was being obtained from the patient — either at all, or it was being entered into the account a few days post-service,” says Long.