WakeMed fortifies its self-pay processes
WakeMed Health & Hospitals in Raleigh, NC, has a long history of caring for all who seek service regardless of the ability to pay, and is currently facing a marked increase in uninsured patients.
WakeMed is an 870-bed not-for-profit health care system that includes five emergency departments (EDs), one of which is the busiest in the state, and two of which are freestanding.
To cope with a surge in uninsured patients, the hospital has built upon its long-standing practices. "A lot of our processes have been in place for a long time. Basically, what we have done is expand them," says Heidi McAfee, RN, MSN, WakeMed's director of patient access/case management.
In 2003, there was a single financial counselor. Now, there is a team of 16. "For inpatients, we work a day behind," says Judy Creel, team leader for the health care system's financial counselors. A report notifies staff of uninsured patients admitted the previous day.
Staff either call or meet with every one of those patients to make sure they are not covered by some type of insurance missed during the registration process. If it is determined that the patient is uninsured, then the staff evaluate eligibility for Medicaid.
Often, staff complete the Medicaid application on the spot. "Our financial counselors complete Medicaid applications on their laptops using a customized Medicaid software application," says Creel. Between 10 and 20 Medicaid applications are completed daily and submitted to Wake County Human Services.
"We also see approximately 70 patients each month who may be eligible for retro-Medicaid," says Creel. "These patients are also managed by the financial counselors. They assist with the submission of the Medicaid application in the month following their discharge from WakeMed."
Same process in ED
An electronic documentation system alerts financial counselors working in WakeMed's EDs if an uninsured patient presents. After the patient is seen by a physician, a financial counselor meets with the patient and completes a Medicaid application when appropriate. The application is then forwarded to Wake County Human Services for processing. Ten applications are completed daily in the children's and adult EDs.
"Our goals are to see every uninsured patient in the ED before discharge, and to complete as many applications as possible," says Creel. "Then, we follow up with that application. We get the patient to provide necessary documents to complete the application process. They can get approved, and hopefully have access to a doctor outside the ED if appropriate."
The new process, which was implemented three years ago, also benefits WakeMed's emergency medicine group of 50 physicians. "They were very pleased with our ability to convert uninsured patients to Medicaid, so that the hospital would get reimbursed," says McAfee. "That has a downstream impact on physicians."
Initially, the financial counselors completed Medicaid applications only for uninsured inpatients. "It was so successful, we decided to roll the same process out in the ED. This change obviously impacted both the physician group's revenue and the hospital's," says McAfee. "It also helps people become eligible for medications and services in the community. The end result is that they will use the ED less frequently."
Previously, WakeMed had no process to determine an uninsured patient's eligibility for Medicaid at the time a child was seen in the pediatric ED. A report was run of every self-pay patient who came through the pediatric ED to demonstrate the potential revenue that could be obtained in this population.
"We contacted these patients to try to get them to fill out Medicaid applications. It was a very labor-intensive process," says Maria Eason, BSBA, project manager of the onsite Medicaid case managers. "Because of the data we had, we were able to get WakeMed to come on board."
Initially, a single position was funded, with additional positions added. Instead of contacting the uninsured patients by mail, the team now meets with them face-to-face while they are still in the ED. "We decided that letters were not the most effective way to communicate with patients. Instead, we put financial counselors in the ED," says Eason.
Patients are represented
Triangle Disability Advocates, whose mission is to represent and assist the homeless and indigent individual in applying for disability and Supplemental Security Income (SSI) benefits, discovered that many of these patients were coming to WakeMed for their medical treatment. "Our director contacted WakeMed and worked out a contracted agreement," says Sonya Withers, BSW, now the manager of the hospital's onsite disability advocates.
Withers and three other contract employees work with patients who may be eligible for disability. If an individual applies for Medicaid, he or she also has to apply for SSI and disability through the Social Security Administration.
"If you don't do that component, you will not get Medicaid for the disabled," says Withers. "Our role at the hospital is to make sure that these applications are processed."
Patients are referred by WakeMed's financial counselors, as well as the case managers at the hospitals and facilities. "We have done a lot of in-service training with the case managers and financial counselors, to help them understand the guidelines for meeting the criteria for disability," says Withers.
This means that when financial counselors are screening uninsured patients, they're able to identify which individuals might be candidates for disability. That patient is then referred to Withers' team.
Consents are signed, medical records are obtained, and examiners are contacted to speed up the process of getting the patient approved. "We can get disability to make a very quick decision to allow Medicaid to come through quicker," says Withers. "The patient goes from being indigent and uninsured to having a monthly income from disability and Medicaid coverage."
Since these individuals will be "repeat customers" for years to come, it benefits the hospital over the long term, adds Withers.
If the patient is denied disability and SSI because Social Security feels the criteria aren't met, the case will be appealed if appropriate. "We will represent them through the whole process," says Withers. "We will go all the way to the level of a hearing with them, if it comes to that point."
Withers' team also coordinates with the case managers on the clinical unit. "This impacts how quickly a patient can be discharged from the hospital. If they are staying here, it's costing the hospital money," says Withers. "Everyone is kept informed of the barriers and the likely outcome, so patients can get the benefits they need."
Patients who are involved with the program are typically very appreciative. Many don't have transportation and wouldn't be able to make multiple trips to the social security office.
"We are working on it while they are in the hospital, so the process is initiated while they are here," says McAfee. "Then after their disability is approved, they have access to services like transportation and health care."
Newest POS collection
Within the last several years, the hospital implemented point-of-service collections in the EDs and outpatient registration areas. A team of three employees contact all scheduled surgical patients. "We go through the operative schedule and verify if the patient has insurance or if they are uninsured," says Robin Finch, RN, BA, team leader of pre-service contacts for scheduled surgeries.
If the patient is uninsured, the case is referred to financial counselors for screening. "When appropriate, the Medicaid application process is started before the patient arrives at the hospital," says Finch.
Previously, if an uninsured surgical patient had a major procedure, the financial counselor would meet with him or her on the inpatient unit. "But if it was a relatively minor procedure and the patient was discharged later the same day, we never saw those patients," says Creel. "In the past, those would be people we would very possibly miss."
For this reason, the same process that has worked well for inpatients and ED patients is now used for scheduled procedure patients. "This is just another segment of the uninsured population at WakeMed that we otherwise might have missed," says McAfee.
[For more information, contact:
Heidi McAfee, RN, MSN, Director, Patient Access/Case Management, WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610. Phone: (919) 350-8173. Fax: (919) 350-8876. E-mail: [email protected].
Maria Eason, BSBA, Project Manager, Wake County Human Services Outpost, WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610. Phone: (919) 212-0459. Fax: (919) 212-0460. E-mail: [email protected].]
WakeMed Health & Hospitals in Raleigh, NC, has a long history of caring for all who seek service regardless of the ability to pay, and is currently facing a marked increase in uninsured patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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