Executive Summary
WakeMed Health & Hospitals obtained an additional $4 million in revenue in FY 2014 by starting Medicaid applications for self-pay patients in two of its EDs. Point-of-service collections for self-pay patients increased by $1 million by the health system doing the following:
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asking all uninsured patients for a $100 deposit;
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giving patients payment plan options;
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Offering Applications For Financial Assistance.
An additional $4 million in revenue was obtained in FY 2014 at Raleigh, NC-based WakeMed Health & Hospitals from self-pay patients in two of its EDs, with a pilot program starting Medicaid applications during the patients’ ED visits.
Without the program, “it would have most likely been charged to bad debt,” says registration supervisor Christopher B. Horton, CHAM, CHAA.
The cost of the case managers who help ED patients apply for Medicaid is a shared expense between WakeMed and Wake County Health and Human Services. “This service has been a great asset to both our patients and our organization,” says Horton.
Payment awareness
Point-of-service collections for self-pay increased an additional $1 million in FY 2014. Horton credits this to simple “payment awareness.”
At WakeMed’s EDs, point-of-service collectors are stationed at the discharge exit 24 hours a day, seven days a week. “Our EDs are designed with one way in and one way out, with the discharge desk at the exit of the ED,” says Horton. “Nurses ensure the checkout by escorting patients to the discharge area.”
Patients are provided with payment plan options and applications for financial assistance. “Representatives verify demographics with the patients and ask them for a service deposit — generally $100 — for both uninsured and underinsured patients,” says Horton.
Pre-registration is key
As a public safety net health system, the Phoenix-based Mariposa Integrated Health System (MIHS) sees a payer mix of 35% self-pay patients who are ineligible for Medicaid, 40% Medicaid patients, 8% Medicare patients, 8% with commercial insurance, and 9% with other types of coverage, such as workers compensation, reports Mary Lee DeCoster, former vice president of revenue cycle at MIHS. DeCoster is vice president of consulting services for Adreima, a Phoenix-based consulting firm that provides revenue cycle service to healthcare providers.
Patient access leaders at MIHS recently set out to improve these three metrics:
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The percentage of patients with elective services that are pre-registered.
This pre-registration reduces registration delays at the time of the visit and gives patient access staff an opportunity to collect copays. “It also adds time to verify insurance prior to the visit and initiate securing the authorization if indicated,” says DeCoster.
The biggest challenge was simply reaching patients. Many use prepaid cell phones with contact numbers that constantly change.
“Staffing constraints also prevented us from making headway in this area,” says DeCoster. “We were always under 50%, well below benchmark.”
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The percentage of uninsured patients that are converted to a payer source, primarily Medicaid.
“This metric is closely monitored, as the liquidation rate to collect self-pay dollars from the uninsured is approximately 2.2%,” notes DeCoster.
An outside agency is used to determine a self-pay patient’s eligibility for Medicaid. “Every uninsured patient presenting to the hospital is evaluated and interviewed, with follow-up, for application to Arizona Medicaid, other government programs, or the MIHS financial assistance program,” says DeCoster. From 2004 through 2009, the conversion rate ranged from 45% to 48%.
“Then the state cut eligibility criteria, eliminating childless adults. The conversion rate dropped to 25% to 28%,” says DeCoster. When the state expanded its Medicaid program in 2014, the conversion rate returned to approximately 48%.
A contracted agency staffed health fairs and weekend events to enroll as many people as possible. “The MIHS enrolled more than 11,000 individuals into either Medicaid or the insurance exchange during the 2014 open enrollment period,” reports DeCoster.
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Total point-of-service collections.
“This is calculated against the opportunity to collect,” says DeCoster. Patient access employees determine what the patient owes for the particular visit.
“Comparing what was collected against the opportunity, MIHS improved point-of-service collections from the mid-20s to over 50%, over a six-year period,” says DeCoster. No patient is turned away for lack of payment. “But each patient is asked for a co-payment,” she says.
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Mary Lee DeCoster, Vice President, Consulting Services, Adreima, Phoenix, AZ. Email: [email protected].
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Christopher B. Horton, CHAM, CHAA, WakeMed Health & Hospitals, Raleigh, NC. Email: [email protected].
