Access Management Quarterly
Initial claim accuracy crucial for SSA programs
Impact of baby boomers felt
Make sure you get everything right the first time.
That's certainly not new advice for patient access staff, but in this case it specifically refers to applications made for coverage of patients by the federal disability program.
With the first baby boomers having reached early retirement age in January 2008, the Social Security Administration (SSA), which also administers the federal disability program, is feeling the impact of that "bulge of people," notes Patti Thrailkill, director of governmental affairs for MedAssist, an eligibility services vendor.
"Retirement claims have started hitting, and this group is also in their most disability-prone years, so there will be more of those claims coming from baby boomers," she adds. "SSA is absolutely inundated with work."
The agency has been underfunded for 30 years, Thrailkill says, and has 30% fewer employees than 12 years ago.
That's why initial claim accuracy is crucial, she says, and why the hospital's self-pay population must be screened immediately to determine eligibility for the disability program.
Medicaid, which administers the Supplemental Security Income (SSI) part of the federal disability program, pays from the date of application, notes Thrailkill. "Say a self-pay patient meets the eligibility requirements and is allowed under SSI. In order to get the date of service covered, you want the screening process to be such that the patient is screened and the application made on day one."
In addition, she emphasizes, access directors should make sure there is someone at their facility with a basic understanding of the process for filing federal disability claims. That could be a staff member if the claims are handled in-house, Thrailkill adds, or a vendor representative if the job is outsourced.
It also is important that as much information as possible be submitted electronically, she continues. "SSA is rapidly moving to an all-electronic disability claims environment and paper significantly slows down the process."
The Centers for Medicare & Medicaid Services (CMS) "has been beating this drum for many years and some hospitals have picked up on it, but a lot have not," Thrailkill says. Despite the national push for electronic storage of the medical record, she adds, "there are now more providers who have not reached that point than who have."
SSA will send a representative to the hospital to explain the process, Thrailkill notes. "It really is easy once there is an understanding, but there has to be someone at the facility that learns it all."
SSA has employees known as professional relations officers, she says, "who are out there trying to educate [providers] about using [the system] as efficiently as possible."
Her experience, she notes, is that most hospitals are outsourcing the process — whether locally or with one of the national eligibility services vendors — and that there are vendor representatives stationed on site.
In those cases, Thrailkill says, "there is an electronic download every morning [as to] who's been admitted and where they've been admitted. The determination is made then on eligibility for coverage."
In instances where the process is not being outsourced, she adds, "what's probably going on is that there is some awareness that the application needs to be filed and someone will give the patient an 800 number to call."
"As soon as that patient gets out the door after receiving care," Thrailkill says, "getting [the hospital] paid is not at the top of the list. The process is intimidating and not easy to understand.
"For any [provider], how to get self-pay patients covered is a big deal," she adds. "Access folks have a lot to do with screening and the direction that paperwork will go. They need to jump on this right away."
The more help that is provided to the patient, the better, Thrailkill notes, and the quicker the process will go. She advises access staff to take these steps to facilitate the claim:
- Electronically transfer medical records as often as possible.
- Provide upfront medical records on the most severely medically compromised patients.
- Provide medical records on long-term inpatients.
It's more important than ever before that access staff make the effort to obtain federal disability coverage for their patients, she says. "State Medicaid programs are drying up and local and state programs don't have the kind of money the feds do to improve the situation."
(Editor's note: Patti Thrailkill can be reached at [email protected].)
That's certainly not new advice for patient access staff, but in this case it specifically refers to applications made for coverage of patients by the federal disability program.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content