Self-Pay Screening

All self-pay patients should be screened to determine if they qualify for funding through one or more entitlement programs, as this can be a key source for reimbursement resulting in a reduction of uncompensated care and bad debt inventory.

 

To determine the quality of a screening process, ask these three questions:

• What percent of your facility’s self-pay admissions qualify for some type of third party reimbursement?
• What is your current success rate? (How many applications were started and approved vs.closed and unapproved.)
• What is the average time it takes to get non-disability cases approved and charges billed?

Tracking these figures gives you the ability to significantly measure the success of your screening process and reveal opportunities that are being missed, increasing opportunities for reducing bad debt and charity write-offs. Obtaining coverage for entitlement programs can be a complicated, time-consuming process that begins with thorough screening for potential eligibility and continues with extensive follow-up to ensure the patient’s cooperation.Whether your facility uses internal staff or elects to partner with an outside vendor to provide these services, it is essential to have a clearly defined, detailed process in place.

To ensure effectiveness our staff:

• must stay current on all federal, state, and county entitlement programs
• meet with the patient prior to discharge whenever possible
• provide transportation to appointments
• conduct home visits to complete the application and collect documentation
• act as an advocate for the patient to ensure all options are presented and thoroughly evaluated
• assist the patient in appeals when necessary.

Appeals are particularly important when assisting a patient in applying for disability through the Social Security Administration. This application process is lengthy and complicated, but it should not be over-looked. Although potential disability applicants account for only 5% to 10% of self-pay patient potential, the dollars equate to 30% of cash recovery due to higher, more frequent bills.