One of the most significant challenges affecting hospitals across the United States is uncompensated medical care. Hospital executives nationwide are diligently working to figure out the best way to address uninsured or underinsured patients seeking healthcare services, totaling over $600 billion over the last 20 years. Bad debt can drastically impact financial viability and can negatively impact patients´ access to care.
The most obvious effect of uncompensated care is the impact to the bottom line of the organization. Hospitals must begin cost-shifting when they are unable to pay for the services provided to uninsured patients. This means insured patients will pay more for services in order to cover the financial loss of caring for the uninsured. It’s also possible that both insured and uninsured patients will avoid or delay treatment altogether due to healthcare costs. If hospitals hope to reduce issues that are commonly brought on by uncompensated care, it’s important for them to implement a solution that works for them and their patients.
According to many industry experts, to more effectively control costs and manage their bottom line, hospitals should:
One way to do each of the above is to partner with CoverMe. CoverMe offers its proprietary marketplace solutions to identify the best solution for every patient, every time.
The CoverMe Marketplace is designed to assist both healthcare institutions and individual patients. CoverMe has a proprietary solution that validates patients’ demographic and health insurance data and then finds potential coverage options and programs for uninsured or underinsured patients.These options may include private, commercial insurance, government-funded programs, financial assistance programs as well as charity and community programs. The Marketplace qualifies patients in real-time with a simple and fast screening process that prevents them from falling into the uncompensated care category.
Another beneficial Marketplace tool is our Retrocheck program . This safety net solution helps hospitals by identifying billable Medicaid, Medicare and commercial insurances that may have been previously unknown or forgotten. The Retrocheck program retroactively assesses if a self-pay patient had insurance coverage at the time of their care and provides the missing information to help bill for those services.
In order to be paid by insurance companies, a patient must provide the appropriate payer name and member ID. Many times a patient will arrive without the required information. This presents a significant problem for the billing staff and may result in a write off! CoverMe’s Coverage Discovery solution allows hospitals to use a patient’s information to identify coverage information for the patient within seconds. coverage information within seconds. When this happens, the hospital is able to be paid for the services resulting in an increase in cash collections and a decrease in charity and bad debt.
Healthcare is more expensive than ever and patients feel helpless by the large and most often unplanned expense. This often leaves the patient believing they have no way to pay the bill. CoverMe recognizes this challenge and has expanded its service offerings by including patient balance financing solution. Through this program, the Company provides a wide range of financial payment options that meet individuals’ needs at no interest or low-interest rates. The overall goal is to help increase net collections while decreasing bad debt write offs and improving patient experience.
Many hospitals have financial assistance programs to improve access to care and reduce patient financial burdens. However, the processes used to identify patient eligibility are often inefficient, thus making it challenging for staff to determine if patients are actually eligible or not.
CoverMe automates and streamlines a hospital’s financial assistance determination process. Hospitals are able to set their own eligibility criteria and rules for their financial assistance programs within CoverMe’s system. Therefore, when a patient’s information is added, CoverMe will screen them and flag patients who qualify for institutional financial assistance. From there, CoverMe will help guide the patient and the hospital representative through the application process. All of the patient information is automatically filled in on the financial assistance application and all data is stored within CoverMe for review.
The Affordable Care Act established a process to allow healthcare providers to make presumptive eligibility determinations for all individuals eligible for Medicaid, based on Modified Adjusted Gross Income (MAGI). The patients are “presumed eligible” and temporarily enrolled in Medicaid. HPE ensures the hospital will be reimbursed for services provided, just as if the individual was enrolled in standard Medicaid at the time of treatment.
CoverMe's proprietary algorithm verifies and confirms the patient's eligibility. Our Hospital Presumptive Eligibility solution takes the guesswork out of complicated manual processes, ensuring patients are covered and providers get paid. CoverMe guarantees hospitals meet their state program compliance requirements.
CoverMe is the industry leader in addressing uncompensated care by offering hospitals and patients a wide range of solutions for the revenue cycle. By identifying real-time coverage that patients may qualify for, hospitals’ uncompensated care burden will decrease, and their bottom-line performance will improve. To see how CoverMe can benefit your organization, make sure to visit our website and request a demo of our state-of-the-art solutions.