How to streamline the eligibility and enrollment services at your hospital

How much attention does your health system pay to your enrollment and eligibility programs? The answer to this question is crucial to the financial performance of your organization. A data by National Health Data reveals that 9.7% people, who were surveyed as a part of the study, were uninsured. As health care costs rise it is important to cut back on expenses and tighten processes.

A shifting payer mix, rise in uninsured patients and a resultant increase in bad debt, have backed health systems into a corner. Meeting the double bottomline of delivering great quality care while strengthening financial stability can be a seemingly insurmountable challenge.

Focusing on an effective eligibility and enrollment program brings down eligibility coverage related denials. It increases the number of patients with appropriate coverage and streamlines the eligibility verification process. Financial counseling services prior to seeking care is a proven way to reduce unreimbursed services.

The patient enrollment program should have a strong slant on researching, identifying and providing patients with the best coverage option for them. Subsidized care plans through a state insurance exchange or low-cost private plans for the short-term are options that can be provided for patients with care affordability issues.

Patient education plays a vital role in reducing enrollment and coverage issues. Patients need to be educated on benefit levels, primary and secondary insurance, out-of-pocket maximums, deductibles, PA requirements and payment responsibilities. This reduces uncertainty, decreases denials due to eligibility issues and improves the patient experience.

There are initiatives like From Coverage to Care, by Medicare that offers patients a wide library of free resources that walks them through how health insurance works and find the right care provider. Multiple resources are available online to assist patients make the right choice. Providing patients with information/access to these resources is vital to develop a successful enrollment process.

Are patients waiting at the front desk awaiting coverage information? Not good. Investing in a eligibility verification software can automate this key process and provide coverage information in near realtime. It frees up in-house staff and reduces wait times. Train front desk personnel to perform batch eligibility checks to save on time.

A strong eligibility verification process lights the way for a healthy revenue cycle. Perform regular audits to your eligibility program to identify and correct fault lines.

Without robust checks and balances in place, even the smallest oversight or inefficiency by facility personnel, staff, or physicians can result in accusations and subsequent audits. It is crucial to have effective systems and processes in place to mitigate the risk of inadvertently falling into fraudulent practices and to ensure compliance with Medicare regulations.