Want to be patient-centric? Expand Eligibility and Enrollment Services

By Nicole Thomas, nThrive Director, Revenue Cycle Solutions | Posted: 08/21/2018

Programs for uninsured

In today’s health care environment of shrinking reimbursement dollars, what does it mean to be patient-centric, especially for those whose patient status is uninsured? Although it may sound like just another buzzword, it’s really about adopting a mindset focused on ways to uniquely support all patients and strive for complete patient satisfaction in every way – body, mind and soul. To do so often requires exploring non-traditional sources of funding through progressive Eligibility and Enrollment services that extend beyond the acute care hospital setting.

Ultimately, our definition of patient-centric means seeking out and qualifying patients for any patient education program that is available to them in the community where they reside, ensuring access to health care.

While it is only natural to question why hospitals should secure coverage for the uninsured following discharge, the answer is really quite simple: it will benefit an organization in some way, perhaps not for clinical reimbursement solutions on a current bill, but definitely on a future one.

For starters, helping uninsured patients gain funding, whether from Medicaid, a qualifying community program or other government assistance, goes a long way toward improving overall patient satisfaction. You’ll be making a very important contribution to their health and helping to avoid preventable re-admissions while also building trust and loyalty as a patient advocate. Those who benefit may feel that “wow, this hospital really does care,” building goodwill in the community you serve. You’ll also be improving your own financial health as these patients continue to receive ongoing health care within your hospital or extended health care network.

Patient Solutions: Expanding Eligibility and Enrollment

Building a robust Eligibility and Enrollment program generally starts by engaging with a vendor or an internal team member, exploring specific options based on a patient’s unique situation.This is a key step to learning how to improve patient satisfaction in hospitals. This includes reaching out to social workers to identify available programs and working with patients to help them through the qualification process. In a number of Florida counties, for instance, there are programs to help uninsured adults engage with a primary care physician following discharge. Eligibility and Enrollment can help secure funding and provide access to a network of participating health care providers.

Another example is extending support to existing Medicaid patients, especially those diagnosed with a terminal illness or who have been involved in a catastrophic accident. In either of these cases, Eligibility and Enrollment professionals can help with application for Social Security disability benefits to cover ongoing health care. Medicaid patients qualify for Medicare two years after being declared disabled, bringing the higher Medicare patient reimbursement rates for services back into the facility with no out-of-pocket expense to the patient.

Another area is neonatal care. If a baby is not well enough to go home, he or she immediately qualifies for a Social Security version of Medicaid. Even if the mother is covered by private insurance, opting for this benefit can help to defray upfront premium hospital costs. Upon discharge, Medicaid may also reimburse hospitals of any premium expenses.

In the case of well babies, parents may simply forget to add their newborn to their health insurance policy, with many health care providers requiring application within 30 days or coverage is denied. Eligibility and Enrollment can obtain access to the birth certificate and social security applications while mother and baby are still hospitalized, faxing these documents to insurance providers prior to discharge to ensure that the baby is covered from the moment of birth.

What to look for in an Eligibility and Enrollment vendor

Due to the complexity of Eligibility and Enrollment, many medical billing organizations engage with an outside resource for these services. However, all vendors are not the same. When evaluating resources it is important to assess the number and scope of programs offered, as well as the depth of knowledge on each.

Below is a chart of programs nThrive manages for Eligibility and Enrollment clients:

  • nThrive Eligibility Enrollment Program

  • What we do

  • Medicaid and Medicaid Waivers

  • Assist patients with applying for Medicaid & Medicaid Waivers programs and assist in maintaining active coverage

  • Hospital- Based Financial Assistance

  • Enroll patients in hospital-based financial assistance programs that are based on income

  • County Charity

  • Secure hospital funding through county and city-based programs

  • State and Federal Disability

  • Apply patients for disability programs and support patients through the appeals process

  • Qualified Health Plans through the Health Exchange

  • Enroll patients in health plans during open enrollment and qualified live events

  • Third-Party Liability

  • Secure hospital funding through third-party liability

  • Medicare Enrollment

  • Reinstate patients that have lost active Medicare coverage due to an event

  • Victim of Crime

  • Secure coverage for patients that are victims of a crime and pursue financial support to cover household bills

  • Newborn Assistance

  • Add newborns to guarantors’ health insurance plans

  • Medicaid Premium Assistance Programs (HIPP)

  • Collaborate with patients and their employers to secure commercial insurance premium payments from Medicaid

  • COBRA

  • Identify patients that qualify for COBRA coverage and secure premium payment from the hospital if the patient is unable to pay

  • Institutional & Long-Term Care

  • Secure coverage for health care and obtain required level of health care documentation from physicians

  • Home Health

  • Ensure patients are actively covered for length of health care required

  • Nursing Home Care

  • Partner with nursing homes to help patients qualify for Medicaid

  • Special Needs programs for Children

  • Enroll children with special needs in state programs they qualify for

  • County Insurance

  • Partner with county health departments to assist patients in obtaining insurance coverage that allows them to receive health care from primary care physicians

  • Prescription Assistance

  • Assist patients in applying for prescription assistance programs to defray the costs of medications

  • Behavioral Health programs

  • Enroll patients in behavioral health plans available to them

Achieving proven results

The measure of any Eligibility and Enrollment program is how well it pays off for patients and health care providers. For one of our clients, nThrive increased inpatient Medicaid approvals by 32 percent, with outpatient Medicaid approvals increasing by 42 percent with our patient solutions. In addition, we helped reduce their overall patient responsibility population, including bad debt, and had quicker access to revenue by identifying the appropriate payor early in the process.

To learn more about how we can help your health care organization achieve similar results, download our checklist, “Five Ways to Offset Patient Liability.” Download our case study on Eligibility Enrollment to learn how nThrive helped a client collect $25 million and decrease uncompensated care.