Patient Access Monthly Source: The Academy of Healthcare Revenue
Begin Financial Assistance Eligibility Screening During Patient Access
Healthcare providers nationwide are seeing a steady increase
in the number of patients in need of financial assistance. The
growing number of uninsured patients, up to 47 million in 2006,
is placing significant financial pressure on providers as uncompensated
care costs rise. Many uninsured patients are in fact
employed; however, the percentage of patients enrolled in
employer-based insurance has continued to decline. According
to the Census Bureau, 59.7 percent of U.S. residents obtained
employer-based insurance in 2006, down from 60.2 percent in
2005. Another group that is growing in size is underinsured
patients. More employers are offering their employees high-deductible
health plans in order to control escalating healthcare
costs. Some plans can have deductibles as high as $2,000,
$5,000, and even $10,000. Although patients with high-deductible
health plans may be covered for catastrophic care, these
patients may not be able to afford their high deductibles, making
them just as vulnerable as self-pay patients.
Even though the number of patients that may be in need
of financial assistance has increased, accurately identifying
patients in financial need remains difficult. Often,
patients must first provide necessary documentation to qualify
for charity care or other financial assistance sources. For
instance, the Deficit Reduction Act of 2005 made the application
process for Medicaid more challenging. The law requires
that patients provide either a passport or a combination of a
state driver’s license and birth certificate as proof of citizenship
before receiving public assistance. This change has primarily
affected legal residents, in that applying for Medicaid or
other public benefits has typically taken longer.
In order to effectively identify patients in need of charity
care or financial assistance, more best performing providers
are beginning financial assistance screening processes during
patient scheduling, pre-registration, and registration, according
to Academy research. A recent Academy survey found that
only 14 percent of providers begin financial assistance processes
after patient discharge, as the following graph shows.
SwedishAmerican Hospital, a 357-bed facility located in
Rockford, Illinois, recognized the vital importance of conducting
financial assistance screening processes at the front-end.
The hospital begins financial assistance processes during each
pre-registration completed for scheduled outpatients. Leaders
at SwedishAmerican implemented the practice of initiating screening processes during pre-registration in order to become
more proactive in identifying patients in need of and eligible
for charity care.
During pre-registration processes, a staff member will ask a
patient if he or she would like to complete an eligibility assessment
for financial assistance or a discount. The assessment process takes approximately five minutes and an overwhelming
majority of patients agree to participate in the screening
process. Staff members utilize a system that screens patients
for eligibility for Medicaid and charity care. The system is programmed
annually with Illinois’ Medicaid eligibility criteria, as
well as with SwedishAmerican’s charity care guidelines. Staff
members request patient information about income, family size
and dependents, and patients’ asset information—for example,
IRAs, bank accounts, or property values. Staff members
will then verify patients’ stated information, with the help of
credit reports, after the system has provided an initial assessment
of eligibility.
After conducting an initial assessment of eligibility through
the system, if a patient is determined to be eligible for financial
assistance, the pre-registration staff member will enter a
charity code into the billing system. The billing system will
then automatically apply a discount or write off the account
as charity when the patient’s bill is generated. If a patient has
assets that must first be considered before determining eligibility
for charity care, the patient’s charity application will be
forwarded to a staff member who evaluates the patient’s application
and asset information to determine if charity care will
be provided and what the appropriate amount of charity care
will be.
The charity care and Medicaid eligibility system for scheduled
outpatients has helped SwedishAmerican decrease bad
debt. As the uninsured and underinsured population continues
to grow, hospitals will likely see more patients in need of
financial assistance. Therefore, it will be even more crucial for
staff members to conduct eligibility assessments before service
in order to educate patients about their financial assistance
options. Doing so may make patients more likely to pay their
remaining medical balances or take advantage of publicly sponsored
benefits, improving hospitals’ financial performance while
promoting their commitment to community benefit.
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Media Contact Andrea Morrill
Research Director
262-782-7919
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