The key to unlocking better reimbursement rates may be integrating multiple revenue cycle approaches as soon as a patient is admitted.
The aftermath of a car wreck or workplace accident that requires hospitalization can be so overwhelming that patients might not be aware of the financial assistance for medical expenses available to them. And during hospital admission, they might not effectively communicate to a patient registrar about potential liability for what occurred.
In many cases, claims of this nature are sent to Medicaid, which is known for low reimbursement rates. Hospital reimbursement from Medicaid varies by state, but it can be as low as 25%. Whereas third parties that may be liable to pay for services generally pay 40%-50% and sometimes close to dollar-for-dollar value.
Many hospitals and health systems don’t have the resources to capture potential Third Party Liability (TPL) or Workers’ Compensation cases in the most effective manner. However, integrating eligibility programs with third-party resources has been shown to ensure faster and better reimbursement and improve the overall patient experience.
Take a Patient-Focused and Process-Powered Approach
MedData studied multiple providers – including large health systems, medium-size hospitals, and community-based, rural hospitals – to identify a process that combines thorough eligibility screening and TPL referral and follow-up. Hospitals and health systems deploying this approach dramatically improved identification of third-party payers and realized faster, better reimbursement.
Leveraging teams of hospital-based screeners, MedData used a patient-focused approach as a means to build rapport and gain the patient’s cooperation from the initial in-house screening and throughout the eligibility process.
By immediately beginning personal contact, these patient advocates were able to identify accurate options for payment assistance in a timelier fashion than relying solely on the hospital’s patient registrar. And, patients were screened for all government programs including Medicaid, SSI/SSDI, Victims of Crime, CIHCP, COBRA, Indian Health Services, Veterans benefits, and any other program that is potentially available.
TPL accounts require a working knowledge of state tort and insurance laws, as well as constant communication and negotiation with the patient, insurance adjusters, and personal injury law firms. Having patient advocates on-site enabled MedData to easily work with TPL experts to navigate the personal injury process for patients – and to send potential TPL accounts that had been identified by Eligibility advocates into the TPL program often on the same day. By integrating eligibility screenings with legal expertise in this manner, MedData was able to identify and coordinate all available insurance to deliver prompt settlements, maximize reimbursement, and ensure payment.
Extending Thorough Follow-Up to Patients at Home, Work, or Elsewhere
Occasionally, screening and application for assistance wasn’t completed before a patient was discharged from the hospital, and the patient may have lost interest in seeking assistance. However, MedData showed that extended outreach through field advocacy – including visits to patient homes, their places of employment, or elsewhere – helped sustain TPL accounts.
With a team of advocates on-site in 43 states, MedData was able to provide the TPL program broad local access to request field visits with patients regardless of their location.
This type of care also had an impact on patient satisfaction levels. Hospitals that used one vendor for multiple services didn’t have to constantly pester patients who were focused on recovering from an injury or accident. This greatly eliminated patient frustration and further improved the overall healthcare experience.
To learn more about how an integrated approach to your revenue cycle can help improve reimbursement, download the full white paper.