Revenue captured increases $1.5 million
Costly vendors no longer needed
Annual revenue collected for Medicaid patients has doubled at Trinity Regional Health System in Rock Island, IL, since January 2010, since the screening process is now done internally instead of by a contracted company.
“We have increased our revenue by $1.5 million to date,” reports Linaka Kain, DE, a Medicaid specialist at the organization.
Previously, an outside contractor screened and applied for Medicaid for self-pay inpatients, and the contractor was paid 18% of all approved and paid Medicaid accounts. “As you can imagine, this was quite expensive,” Kain says.
Two years ago, the hospital switched to using two Trinity-employed Medicaid specialists for the health system’s Bettendorf, Moline, and Rock Island campuses. “We are now able to screen all of our self-pay patients, not just the inpatients,” she says. “We are saving our hospital system a significant amount of revenue by doing this ourselves.”
Self-pay form used
Patient access managers created a self-pay form, which all registration staff use at the time of service in all inpatient and outpatient departments throughout the hospitals. [The form is included with the online version of this month’s Hospital Access Management. ]
This tool is used to screen every self-pay patient for possible eligibility for Medicaid, and it alleviates duplication of efforts, says Mary Kay O’Keefe, the other Medicaid specialist on the team. “The results are documented in the patient’s account. Those notes are made available to all appropriate staff, including financial advocates, case managers, and the central billing office,” says O’Keefe.
Of the 1.7 million currently uninsured, 540,000 will become eligible for Medicaid in 2014, according to estimates from the Illinois Department of Human Services (DHS). “The measures we have already implemented will put us in good standing to be on the forefront to coordinate and improve care to all of our patients,” O’Keefe says.
Here is how the process will work when healthcare reform is implemented for a patient being admitted through the emergency department:
• The patient is screened with the self-pay form.
• If the patient is determined to be possibly eligible for Medicaid, the self-pay form is sent to the Medicaid specialists for follow up, and they determine whether the patient is eligible for benefits.
• A Medicaid specialist meets with the patient, completes the application process, and files the case with DHS.
• The patient then becomes “Medicaid pending” in the hospital system, returns to the emergency department, and then is admitted as an inpatient.
“When the patient is in-house, they become eligible,” O’Keefe says. “This enables us to bill DHS for all services and eases the patient’s concerns about their bills.”
It also allows case management to coordinate discharge planning for skilled nursing facilities and utilize medical equipment, oxygen, and pharmaceutical medications. “Without the approval in place, these would not be available to the patient, which might hinder continuity of care,” O’Keefe says.
Sources
For more information on processes for identifying Medicaid-eligible patients, contact:
• Jennifer Cameron, MBA, Director, Patient Access, Children’s National Medical Center, Washington, DC. Phone: (202) 476-6258. Fax: (202) 476-4680. Email: [email protected].
• Stephen Hovan, Vice President of Revenue Cycle, The University of Tennessee Medical Center, Knoxville. Phone: (865) 251-4534. Email: [email protected].
• Linaka Kain, DE, Medicaid Specialist, Trinity Regional Health System, Rock Island, IL, Campus. Phone: (309) 779-2648. Email: [email protected].
• Mary Kay O’Keefe, Medicaid Specialist, Trinity Regional Health System, Moline, IL, Campus. Phone: (309) 779-3853. Email: [email protected].
• Veronica Rodriguez Patricio, Audit/Appeals/Quality Assurance/Training Manager, Eligibility & Registration Services, Harris Health System, Houston. Phone: (281) 372-3150. Email: [email protected].
Annual revenue collected for Medicaid patients has doubled at Trinity Regional Health System in Rock Island, IL, since January 2010, since the screening process is now done internally instead of by a contracted company.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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