By Ana Lopes, Manager, Medicaid Eligibility Services, William Koczan, Senior Manager, Medicaid Eligibility Services and Michael Lopez, Manager, Medicaid Eligibility Services
Changes in the healthcare Landscape
The healthcare landscape has been fundamentally changed due to the COVID-19 pandemic, which has forced the industry to redefine operational processes and deliver healthcare services in a new environment. In-person visits now entail additional safety measures and many office visits have been transitioned to telehealth interactions.
As revealed in the recent Harris Poll conducted on behalf of UPdox, 42% of Americans have used telehealth services during the pandemic, and of those, 65% enjoy the convenience, while 63% see it as a way to avoid being exposed to other sick patients.
Medicaid in the virtual space
Even before COVID-19, patient intake management had been steadily introducing digital solutions across the healthcare industry, and the pandemic has accelerated this trend. During the pandemic, the virtual space has helped to keep site teams safe while maintaining a patient-centric approach, offering patients peace of mind and enhancing patient satisfaction. Virtual solutions have allowed healthcare organizations to increase patient safety while reducing the spread of infection.
One area that has proven to be challenging during this new paradigm has been the enrollment of hospital patients into applicable federal and state programs. For Medicaid enrollment, specifically, the ability to enroll patients has always been challenging, and the lack of patient engagement in this new environment has added additional complications. Obstacles such as language barriers, patients suffering from cognitive deficits, and/or limited access to technology have been the most notable. These obstacles have not just been limited to patients; providers have struggled with telehealth workflow, platform adaptation and establishing meaningful connections with their patients.
Whether it involves completion of key documentation prior to a healthcare encounter or participating in their patients’ care plans, providers are striving to find innovative ways to increase patient engagement to improve outcomes. Virtual innovations include secure email and texting, online pre-registration forms and kiosks. In addition, many organizations have been relying on non-traditional healthcare workers to provide additional patient support in this new environment.
Essential first step
Although telehealth utilization rates are on the rise as a means to provide continuity of care, patients in need of medical attention for acute medical conditions continue to utilize the hospital emergency room for treatment. Capturing key patient data prior to care has become increasingly important in order to decrease the likelihood of a patient being denied Medicaid coverage, with their corresponding account often incorrectly sent to patient collections.
Hospital registration personnel provide the essential first step in the patient intake process (the first element of the revenue cycle). Key pieces of information especially important for Medicaid eligibility, such as demographics and financials, are collected during this phase. Unfortunately, this information is commonly missed or entered incorrectly by frontline staff.
Before COVID-19, patient access departments worked with eligibility support staff to provide face-to-face customer service, distribute information and obtain required documents. In addition, patient access was responsible for collecting accurate patient information and point of service collections. These processes were time-consuming to get right, but, perhaps more importantly, they are now not always applicable in the post-COVID-19 environment of a contact-less office. Presently, the pandemic has increased demand for patient access representatives for many hospitals. The lack of adequate staffing has contributed to the inability for many organizations to streamline the patient intake process in this new environment.
Accurate patient registration prevents errors and denials in the back end of the revenue cycle process. To help mitigate issues in this new landscape, hospital organizations are now implementing proactive policies and protocols, particularly to help streamline the presumptive eligibility process for Medicaid enrollment (in states where presumptive eligibility applies). Many locations are now conducting intake interviews via video, redefining traditional roles, and providing document drop off points for eligibility determination.
Key points to think about:
- Patient information misclassification
- How to mitigate or reduce patient misclassification to self-pay?
- How to capture essential patient demographic information especially in the following areas?
- Emergency contacts/third-party contacts
- Patient address
- Financials such as insurance carrier
- How to stay connected in person with patients?
- How to reduce difficulties of obtaining in-person patient consent?
Recommended Strategies:
To improve the Medicaid eligibility process in this new environment, it is important to open lines of communication especially between the hospital’s eligibility support staff and the hospital’s financial counseling team. Also paramount is reestablishing connections within vital departments such as the patient access teams. Working hand-in-hand is crucial to optimizing the best approach in obtaining required information for Medicaid application and insurance processing.
Key points in communication:
- Gratitude, an overlooked concept.
- Many of these internal teams have been in the trenches and are experiencing strained resources since the start of the pandemic. Acknowledging their efforts lets them know how much they are valued. They need to be reminded that though they have been pushed to their limit, they are meeting the needs of the community and are being supported in their efforts.
- Ask how can we help?
- Collaborating with internal teams by streamlining strategies will help improve communications between departments, both internally and virtually.
- Reduce misclassifications.
- Increase application processing leading to supporting the overall hospital’s financial objective.
Collaborating with hospital support and executive staff contributes to increasing efficiencies in moving patients through the registration pipeline.
Key performance indicators that hospitals need to utilize in evaluating their registration processes are:
- Insurance verification
- Pre-registration
- Volume of self-pay admissions
- Emergent vs non emergent
- Number of patients screened
- Denials
Working proactively with patient intake personnel not only reduces errors but saves time for the patient and improves cost savings to hospitals. In addition, optimizing the registration process improves the patient experience, especially during the integration stage, which can feature new and unfamiliar communication technologies.
CBIZ KA Consulting Services has worked with a number of clients during the COVID-19 pandemic to streamline and improve patient registration and eligibility processes, including the introduction of our new Touch-Free, Patient-Facing Eligibility™ process. For additional information about CBIZ’s services in these areas, please contact Juan Chico at jchico@cbiz.com or 609-918-0990.
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