Identifying the right payer before a healthcare service is provided and billing on time, reduces costs, prevents bad debt and maximizes reimbursements and revenue.
Recent data from the CMS indicates that Medicaid enrollment grew by nearly 10 million between February 2020 and January 2021. The jump was precipitated by a combination of factors, including the economic fallout of the pandemic and the Coronavirus Relief Act adopted by Congress that gives states extra federal money to keep people on Medicaid rolls until the end of the public health emergency.
Despite the spike in enrollment, the Kaiser Family Foundation estimates that the overall uninsured rate may not have changed substantially with tens of millions of people still without coverage.
Why do people remain uninsured or underinsured? There are several reasons: Affordability of premiums and out-of-pocket costs, lack of knowledge about payment options, ineligibility because of immigration status.
Uninsured people are more likely to postpone or forego healthcare and skip preventive services, leading to chronic diseases and preventable conditions going undetected. They also tend to use emergency rooms as their primary point of care, seeking care only when it is no longer avoidable.The current pandemic is further exacerbating the situation.
Beyond significantly increasing the health risk of patients, lack of health insurance coverage also creates significant financial implications for providers. Uncompensated care on average accounts for 8% of hospital expenses. According to the American Hospital Association, hospitals have provided more than $702 billion in uncompensated care for their patients since 2000.
Lack of insurance can have dire financial consequences for providers and patients. For providers it means the cost burden of uncompensated care. For patients it can mean debt, credit issues and even bankruptcy.
The question then is how can successful organizations intervene and assist the patients who fall through the cracks in the healthcare system? When the uninsured seek care due to an emergency or acute exacerbation of a chronic condition, the incident creates a window of opportunity for provider organizations to intervene and engage with the patient. There is an opportunity to educate people on available services, determine whether they are eligible for Medicaid or perhaps some other coverage and then to facilitate the process and paperwork.
Historically, hospitals have attempted to engage self-pay patients at the point of service or after the service is rendered to convert them to a funding source. That's a major challenge for hospitals even before the pandemic. And patient cooperation can drop by 33% once they leave the care facility.
As the vaccine rollout accelerates and people return to the workforce, the number of people eligible for Medicaid is expected to drop, leading to an increase in the number of self-pay patients. While this could vary based on the geography and demographics, it is likely to increase the burden on providers. Providers will need to up their patient-engagement game to thrive in the new normal.
Digitally enabled solutions are the answer to engaging patients early in their financial journey —even before they set foot in the care facility. On the one hand, they help patients seamlessly navigate the financial process and improve access to care. On the other, they protect revenue for providers and give patients peace of mind by helping to increase Medicaid enrollment and renewals and identify alternate funding sources.
Insurance discovery. A digital portal can help identify the right payers for service reimbursement prior to service, across payers: commercial Insurers, Medicaid and Medicare. Such solutions also help identify secondary coverage, maximizing reimbursement from uncompensated care and underpaid accounts.
Financial assistance screening and enrollment. Many uninsured and underinsured patients are unwilling to access charity care due to the stigma associated with it. Digital portals help patients navigate government and charity care and enroll in eligible programs from the privacy of their homes. The portal can be designed to enable patients to log in and answer eligibility screening questions when it is convenient for them and and using their own smartphone or computer.. Patient advocates can then follow up with qualified patients via telephone, as needed, for full screening and possible enrollment in programs from VA, Indian Health Services, and the like. Some patients may be eligible for programs set up for people who are victims of crime. Workers compensation and COBRA are also possible sources of coverage.
Insurance verification. Nearly 50%t of patients say that a clear estimate of financial responsibility will impact whether they will see a particular provider or not, and 70% are more likely to pay if they receive an estimate on the day of service. A digitally enabled solution drives real-time or batch verification, claim status monitoring and fraud mitigation. It checks the status of patients’ deductibles and co-pays based on their coverage — across the billing process — from scheduling and pre-registration to registration and discharge in near real time.
Digital document submission. Using a patient portal, patients can upload legible images of the required documentation within a secure framework, eSign documents, and track documentation status, conveniently fast-tracking the process.
The pandemic has accelerated consumer adoption of digital solutions across industries, including healthcare. Electronically engaging patients, gathering documentation, identifying funding sources, and enabling enrollment mitigates face-to-face interactions during the pandemic while enhancing patient convenience and satisfaction.
For providers, digitally enhancing patient engagement and providing clarity into patient financial responsibility translates to a higher payment yield. By identifying the right payer prior to service and billing them on time, it reduces costs, prevents bad debt, and maximizes reimbursements and revenue.
Most importantly, it gives those without coverage peace of mind about how they are going to pay for their care — the solution to helping those living in the cycle of seeking urgent care without any mechanism to find funding sources.
Nate Allen is senior vice president and eligibility practice Leader at Firstsource.