New eligibles will turn to access for help: Don’t be caught unprepared
Financial counseling role is in the forefront
(Editor’s Note: This is a special issue of Hospital Access Management on how the Patient Protection and Affordable Care Act [PPACA] will change patient access processes. Inside, we cover how patient access staff will help newly eligible patients to obtain coverage, what steps to take to handle increased patient volumes, how to change processes for self-pay patients, why healthcare reform makes customer service a top priority, and new requirements for informing patients on charity care programs.)
“Your deductible is $2,000. How would you like to pay that?”
This information simply won’t be enough for registrars to offer patients when the Patient Protection and Affordable Care Act (PPACA) takes effect in 2014, according to Luis Guerrero, director of patient access services at Ochsner Baptist Medical Center in New Orleans.
Patient access departments will be in a position to offer far more help to patients than they do currently, including detailed, accurate information on various coverage options, he says.
“It is not enough to say, ‘You will owe this amount of money. I can refer you to financial counseling,’” Guerrero says. “Registrars have to become more analytical, based on the information they have in front of them.”
Jack Smarr, MHA, associate director of revenue management for UK HealthCare in Lexington, KY, says, “Brush up on your financial assistance and charity care policies. Be prepared to accommodate an influx of newly insured people into your system.”
At UK HealthCare’s Patient Access Center, where all clinic visits are scheduled, patient access staff will need to know which patients are qualified for coverage and how to begin the process of enrollment, says Smarr.
Even if the number of self-pay patients reduces over time as healthcare reform takes hold, providers and patients alike will continue to struggle with confirming eligibility, communicating benefit coverage, and defining patient responsibility/liability, says Laura A. Semlies, vice president of finance at North Shore — Long Island Jewish Health System in Manhasset, NY.
“At North Shore — Long Island Jewish, the customer experience related to patient access and other related administrative functions has recently taken the spotlight,” she reports.
The organization launched a multi-year initiative to completely transform their revenue cycle to meet demand for self-service capabilities such as online scheduling and kiosk-based check-in, and more sophisticated financial coordination including comprehensive eligibility checking, liability estimators, and financial counseling for those requiring support with coverage applications and/or payment plans, says Semlies. She recommends taking these steps to prepare for healthcare reform:
• Implement comprehensive eligibility checking to perform real-time confirmation of coverage.
• Implement tools and processes to estimate and communicate patient liability in advance of care.
• Establish financial counseling role to provide options for patients with significant liability as well as to provide support for self-pay patients seeking coverage.
• Enhance patient access analytics, including routinely monitoring payer mix adjustments, financial coordination performance, and patient liability estimate accuracy.
“Lines will blur”
“Patient access departments who already have a good working relationship with their state Medicaid offices will definitely have an advantage,” says Smarr. “Contact your state Medicaid office and get in on the ground floor of their planning.”
Ochsner Baptist Hospital’s registrars and pre-service specialists now direct patients to financial counselors to file applications for Medicaid, Medicare, social security, and charity care in the moment the need is identified. “In the past, financial counseling was taking place at the end of the cycle. Now it is taking place at the very beginning of the cycle,” says Guerrero.
Previously, financial counseling occurred at the end of the cycle or when the patient received the bill, but it is now part of the registration and scheduling process. Under healthcare reform, registrars will perform even more financial counseling earlier in the process — not just for uninsured patients, but also patients with high deductibles and coinsurance, says Guerrero.
Registrars will use the online portals of the health insurance exchanges to be set up by the state, to guide patients through the process of obtaining coverage, he explains. “Registrars, and access, and financial counseling will be more closely related, to the point where the lines will blur,” Guerrero says.
Expanded role
The intent of healthcare reform isn’t to have patients struggle to figure out how to obtain coverage on their own, says Guerrero. In fact, this responsibility soon will be part of the job of patient access employees.
“Our financial counselors will have all the tools to help patients obtain the proper insurance, whether state-funded or not,” he says. “It’s not just Medicare or Medicaid or traditional options any more. We are operating on the assumption that everybody is going to have some kind of coverage.”
Smarr expects to see a decline in self-pay patients in 2014, but he says that he expects that point-of-service collections will remain an important aspect of the revenue cycle. UK HealthCare’s financial counselors assist patients in understanding their eligible coverage through state Medicaid or disability, he says, and this assistance will continue under healthcare reform.
“People will initially present to the hospital and clinics as uninsured,” he says. “They will need assistance in signing up for the government health insurance, much like they do today, when someone presents as self-pay.” (See related story on preparing for increased volumes, below.)
Sources
For more information on financial counseling done by patient access employees, contact:
• Luis Guerrero, Director of Patient Access Services, Ochsner Baptist Medical Center, New Orleans, LA. Phone: (504) 842-2912. Email: [email protected].
• Laura A. Semlies, Vice President of Finance, North Shore - Long Island Jewish Health System, Manhasset, NY. Phone: (631) 414-1463. Email: [email protected].
• Jack Smarr, MHA, Associate Director, Revenue Management, UK HealthCare, Lexington, KY. Phone: (859) 227-4921. Email: [email protected].
Patient access departments need to prepare for a “great increase” in the volume of patients who are eligible not only for Medicaid, but also private insurance policies, as a result of the Patient Protection and Affordable Care Act (PPACA) according to Luis Guerrero, director of patient access services at Ochsner Baptist Medical Center in New Orleans.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