Quarterly Report no marks

QUARTERLY REPORT
MARCH 2016

ARE YOU WINNING?

Hospital Vs. Self-Pay Dollars

FOLLOW-UP IS KEY

to effective Medicaid reimbursements

EXPANSION & NON-EXPANSION

3 years later, how the Healthcare Marketplace
impacted your self-pay dollars

RESOURCE CORPORATION OF AMERICA

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Dear Hospital Management,

As a trusted partner and resource to our clients,
we are continually asked to provide education
and expertise in the field of eligibility and other
areas of the hospital revenue cycle. Through
strong relationships, we have helped hospitals
recover billions of dollars in revenue from their hospital
self-pay populations and it is our pleasure to bring this
knowledge to healthcare professionals across the country
through our new quarterly report.

Thanks for reading.

Sincerely,

James Finklea
Executive Vice President

RESOURCE CORPORATION OF AMERICA

HOSPITAL VS. SELF-PAY POPULATION

ARE YOU WINNING?

Losing self-pay dollars is not a ing account progression, it’s a
fight you should walk away from. red flag that the current process
Whether your facility manages eligi- may be hurting the bottom line.
bility in-house or has partnered with a
vendor, there are still parts that need 3. Payment follow-up - Your eli-
monitoring to make sure you and gibility vendor or in-house team
your patients come out the winners. needs to make payment follow-up
a priority in the recovery process.
We have been We find billing and
asked to perform payment to be an
hundreds of eligi- easily missed task
bility audits to de- and a costly point in
termine if money the revenue cycle.
is being left on the A successful eligi-
table; below are the bility process does
biggest pain points not end with follow-
we evaluate during up. The most im-
a standard review. portant piece is en-
suring the hospital
1. Promptness receives payment.
of Inpatient screening - It is easy
to assume the patient is being Depending on the patient mix, self-pay
screened for government assist- numbers can range making it hard to de-
ance before they leave the facility, termine exactly how much a hospital’s
but unfortunately that is not always recovery should be. Typically, we’ve
the case. This is the first place our seen anywhere from 20-30% of self-
experts evaluate. To make a quick pay populations qualify for assistance
determination and build a relation- in non-expansion states and conver-
ship with the patient, your eligibil- sions rates on net placements between
ity team needs to be doing screen- 91-96%. We suggest you take a closer
ings within 24 hours of admission. look at the above-mentioned points of
your eligibility process if your num-
2. Follow-up on account progres- bers seem lower than our expert advice.
sion - It is very important to moni-
tor self-pay accounts regularly. If Bethany Bailey
we don’t see regular notes made Vice President and Eligibility Expert
in the hospital system regard-

RCA Quarterly Report Page 3

Time is running out...

Follow-up is KEY to
Medicaid reimbursement

For best results and timely reimbursements,
follow-up needs to be rigorous and consistent.
RCA has heard from multiple clients that their eligi-
bility vendors failed to stay on top of accounts and
the money eventually ran away from them. Noncom-
pliance and difficult patients are pain points that are
made easier through constant contact and account monitoring.

From the minute your uninsured patient leaves the hospital, the clock begins tick-
ing and that revenue becomes harder to recover. In many cases, patients are hard
to reach by phone, do not respond to mail correspondence and even the most thor-
oughly trained staff will struggle with gathering the much needed documentation for
maximum reimbursement.

We’ve found that weekly communication to the
case worker, agencies and the patient is critical to
shortening the amount of A/R days to payment.
In search of discharged patients, sometimes this
consists of measures including home, jail and
shelter visits, transportation to and from appoint-
ments, translations services and skip traces.

RCA Quarterly Report Page 4

3 YEARS INTO THE
HEALTHCARE MARKETPLACE

Over the past three years, RCA has embraced changes that the Afford-
able Care Act has given us and instead of viewing them as challenges,
we have found an opportunity to be at the forefront of it.

As a Certified Application Counselor Organization, we provide educa-
tion and assistance to our hospital client patients and general public
enrolling in the healthcare exchange. Our clients turn to us with ques-
tions and concerns that we can confidently address for them.

So, are people signing up?

The answer really depends on whether or not your state expanded Medicaid.

In non-expansion states, there is still a gap of uninsured people that
do not qualify for Medicaid and insurance premiums are too high for
most to afford. Since the government knows this, they have waived
the penalty fee for those taxpayers in non-expansion states who do not
qualify for Medicaid. The result of this has been less enrollments and
the self-pay population remaining largely unchanged.

If you are in an expansion state, chances are you have seen a decline in
the self-pay population. With that decrease, healthcare professionals
are going to see more Medicaid; however, the reimbursements in some
cases have been reduced. For hospitals, finding revenue in remaining
at-risk populations, such as non-citizens, has never been more impor-
tant than it is at this point in time.

Certified Application Counselors for the

Converting at-risk dollars into
revenue for 22 years.

Third-Party Medicaid Eligibility
Third-Party Liability/ MVA Lien Filing

Medicaid Denial Management
ProfitPal™

Safety-Net Eligibility
Financial Counseling
SSI/SSDI & VA Claims
Healthcare Exchange Enrollment
Charity Applications

RESOURCE CORPORATION OF AMERICA
www.RESOURCE-CORP.com

RESOURCE CORPORATION OF AMERICA
1120 MARINA BAY DR
CLEAR LAKE SHORES, TEXAS 77565

VISIT US AT THE HFMA DIXIE INSTITUTE FOR A CHANCE TO WIN WINE FOR A YEAR!

* HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.