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The Value of a Comprehensive Eligibility Screening Process

Qualifying eligible patients for Medicaid, Medicare or commercial insurance as soon as possible impacts a hospital’s revenue cycle in many ways: increased revenue, decreased denials, reduced days in accounts receivable and improve discharge planning.

“A comprehensive and hands-on eligibility screening process reduces bad debt and increases the opportunities to maximize reimbursements from other payment sources,” Dave Wojczynski, President of TransUnion Healthcare, stated in a press release.  “A complete revenue recovery approach that looks for additional combined coverage for Medicaid, Medicare and commercially insured patients can increase revenue, decrease costs and prevent bad debt.”

Obtaining eligibility at the bedside or in the Emergency Department starts the billing process immediately.  As a result, accounts are paid faster thus reducing accounts receivable.  In addition, identifying insurance sooner gives the Patient Financial Services (PFS) team more time to work accounts.  As a result, when the PFS needs patient follow up they can reach out to the eligibility team, which has already established a relationship with patient.

Rapid eligibility screening leads to a decrease in billing denials.  For example, if it is discovered that an inpatient has insurance, the notice of admissions (NOA) and the billing process could be initiated immediately.  Enrolling patients faster leads to fewer timely filing denials and makes it easier to get supporting documents from the clinical team.  

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Early screening also assists with discharge planning, which leads to inpatient beds being turned over quicker.  As a result of Medicaid expansion as part of the Affordable Care Act, programs such as presumptive eligibility enable some patients to be enrolled in Medicaid prior to discharge.  Consequently, patients can be placed quicker and into a more appropriate setting of care upon discharge.

Qualifying eligible patients for Medicaid as soon as possible can improve a hospital’s revenue cycle.  In addition to direct revenue cycle effects, eligibility services at healthcare facilities can improve the discharge planning process, leading to better operations and improved patient satisfaction. 

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