Patients may abuse financial assistance
More questions are asked
At Medical College of Central Georgia in Macon, the Care Partners Program offers financial assistance for chronically ill patients in order to reduce unnecessary hospitalizations, says Jane Gray, CPA, FACHE, FHFMA, assistant vice president for the revenue cycle.
"A diabetic or person with high blood pressure in a lower socioeconomic environment may have a hard time complying with their plan of care," says Gray. "We try to address their financial needs so they can manage their illness. We have seen some good results with that."
When the Care Partners program was implemented, "we discovered a good bit of identity fraud as part of that process," she says. "People were sharing their eligibility cards."
It also was discovered that some people receiving financial assistance had access to insurance coverage, but they opted not to take it because they already were receiving financial help, reports Gray. "We added a new rule to say that if you have access to insurance, you are not eligible for assistance," she says.
Gray that while her department saw an increase in identity theft a few years ago, this problem has leveled off. "I think people are much more aware of the risk than they used to be," she says. "The industry in general is asking more questions and doing a better job of validation."
For face-to-face encounters, says Gray, patient access staff always ask for ID. "Of course not everybody can produce a photo ID. That tends to be a red flag," she says. "We ask if they have for any kind of ID. It may be a work badge or credit card. We take what we can get, to give us a greater comfort level."
Over the phone, staff ask for several identifiers, says Gray. "We take great care in doing due diligence. We want to be sure we are talking to the right person who has a right to that information," she says. "If we get anything off what we have on file, we ask for another validator."
Many times, says Gray, staff have taken calls from people posing as others to obtain information they don't have a right to. Parents might not understand that they don't have the right to ask for information on their grown children, she adds. "Some people are nosy. There are a lot of family dynamics that can come into play," she says. "If we start asking detailed questions, they will usually just hang up."
At Medical College of Central Georgia in Macon, the Care Partners Program offers financial assistance for chronically ill patients in order to reduce unnecessary hospitalizations, says Jane Gray, CPA, FACHE, FHFMA, assistant vice president for the revenue cycle.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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