Real-Time Financial Assistance Screening and Workflow Management
With the rapid rise in healthcare costs, patients are being asked to share the burden of those increased costs through higher co-pays and larger deductibles. Other factors, including the slow economy, layoffs and consumer-directed health plans, also are forcing patients to pay an increased portion of their medical costs. Therefore, how facilities manage patient pay portions and charity is becoming increasingly important to the fiscal health of hospitals and medical centers. By addressing the entire financial assistance process, a facility can become a patient’s advocate and demonstrate that commitment to the local community and state government.
ActiveASSIST provides all the tools a facility needs to identify, manage and track the entire financial assistance process including the workflow around managing the patient account. The solution is fully integrated with the Patient Account Rank Order (PARO) presumptive charity system to help identify financial counseling prospects. The PARO system determines the likelihood that a patient will qualify for financial assistance based on demographic data modeled from surrounding communities and historical charity approvals previously made by the hospital.
ActiveASSIST provides numerous benefits to hospitals and medical centers, including:
Availability Anytime, Anywhere – at point of (pre)registration, bedside, PFS, and in the field
Consistency – guarantees that all patients are given the same fair and level assessment.
Refocused Collection Efforts – redirect collection activities based on ability to pay
How It Works
PARO joins its charity analytics with a proprietary payment score that helps identify which patients are likely to make a payment and which patients should be extended financial assistance options. This predictive model, coupled with a basic questionnaire integrated into the (pre) registration process, enables ActiveASSIST to identify a likely prospect and route the patient history, visit information and electronic application forms to internal counselors or hospital-approved vendors for follow-up.
Quick Screens – basic questionnaires combined with the PARO presumptive charity result identify likely prospects for financial assistance early in the revenue cycle.
Plan Code Recommendations – recommended plan codes are presented to the registrar based on business rule selection and prioritization based on the “payer of last resort.”
Calculation of Charitable Co-Pay
Full Assessments – comprehensive interview captures detailed information in the facility, in the field, or at contracted vendor locations.
Workflow and Reporting
Determining that a patient is a candidate for financial assistance is a key step in the process, but it is by no means the entire process. ActiveASSIST monitors progress and documentation requirements in order to escalate accounts that are not progressing at an acceptable pace. In addition, follow-up tasks are tracked and monitored to ensure that progress is made and that accounts don’t age unnecessarily due to neglect. Specific documentation requirements can be enforced for each assistance program, and deficiencies can be flagged and assigned to associates for resolution.
These same capabilities can be extended to a hospital’s vendors enabling all participants to share information throughout the process. The hospital retains control of the account and is then able to quickly transition accounts from vendors back to internal counselors and managers.