Patients naturally assume everyone they come in contact with at a facility is a hospital employee.  Onsite vendors are often seen as an extension of the facility and should represent the hospital’s values beginning with their first impression.  This is why a trusted partner should work hard to integrate themselves into your facility.

Once performance and competencies are vetted, a facility should also consider how a vendor’s presence could affect the organization.  Do not let time or financial constraints impede a very important component in choosing the right vendor.

Consider these questions in evaluating your vendors overall professionalism:

Does your vendor staff…

• Dress in professional attire, which meets the acceptable code of the hospital?
• Demonstrate an understanding of the facility’s values and corporate culture?
• Represent the organization with appropriate business etiquette?
• Exhibit compassion and courtesy while meeting with your patients?
• Practice punctuality and professionalism in their role as your vendor?

RCA is known for its superior eligibility services and high conversion rates, but we also receive a number of compliments about our staff’s professionalism.  Our employees are trained to establish themselves as a resource to our client hospitals. We have been so successful in the process that RCA team members have been awarded multiple times with hospital accolades.

 “I just wanted to let you know that Carlos won the “Extra Mile Award” for the month of August for [our facility], which is the first time a contract employee has earned the award.  The way it works, our leadership team takes nominations, then the management team votes.  I was told by HR that Carlos had about 90% of the votes.  It is definitely the highest employee award given at the hospital.  He continues to do a great job to ensure that RCA is well represented.”

-Director of Patient Access

During the onboarding process, RCA recruits the most talented candidates for employment using our own top performing staff as the baseline for results in both skill and aptitude.   As we continue to elevate the bar for a higher caliber organization, our clients can remain assured that the top performing and respectable workforce is in front of their patients.

Resource Corporation of America understands that a valued partner should have extensive knowledge with processing Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cases. We take these claims seriously and work tirelessly to ensure that your patients are not only guided through the entire process, but have someone who will keep them informed of their status, assist with the completion of necessary paperwork, file timely appeals when necessary, and properly update their claim with medical records and any documentation requested from the Social Security Administration. We also maintain constant communication with our partner facilities throughout this process so that case management has the most up to date information about case status and eventual determinations.    

Close Relationship with case management

During the course of an SSI/SSDI case, it can be difficult for case management to get updates on pending cases. Our patient support representatives are trained to take a proactive approach in gathering updates and are held to a standard of obtaining those updates every seven days or less. We also align our database with your facility’s database in order to have a seamless transfer of information. This allows us to provide instant updates to your system as we update our own. We work these cases proactively so that your case management team is provided with updates before they ever have to ask for them.

Timely Appeals

Being proactive with our updates also means that we are diligent with filing timely appeals should a claim be denied by the Social Security Administration. Failure to provide a timely appeal can result in the denial of a claim for your patient. As a result, our representatives stay focused on appealing the Social Security claim weeks prior to the deadline, which is typically sixty days from the date of denial. When we are notified of a denial for an SSI or SSDI claim we immediately begin work to file the appeal and obtain any new medical documentation that may be of assistance to the patient’s claim.  

Accredited Disability Representation

All of our disability representatives are accredited by the Social Security Administration to provide disability representation to our claimants. This means that each of our representatives have passed an exam certifying that they are proficient in the representation of disability claims. As a result of their accreditation they are permitted to represent a patient through the hearing process and file an appeal with the Appeals Council in the event of an unfavorable hearing decision. Further, because our representatives are non-attorney representatives, they will never charge for medical records or for phone calls to provide updates to case management or to the claimants themselves. 

Follow-up Through Entire Case Regardless of Representation

We provide follow up throughout the life of a Social Security case, regardless of whether a patient chooses to use our accredited representatives or another form of representation. We understand that in some cases a patient may seek out an attorney to handle their claim, but our rigorous follow-up processes remain the same in that situation as well. Our responsibility is to the patient and to the hospital to exhaust every option in order to have any and all outstanding medical bills paid. In order to accomplish this, we must continue to not only update the claim but stay in contact with the patient’s chosen representative. This allows our office to keep our system updated and provide those updates to case management.  

Agency Connections and Relationships

Our patient support representatives go above and beyond for our patients. Not only do they provide constant updates, but they also go out of their way to complete forms and assist in all aspects of the Social Security case.  This often means that they develop strong relationships with the patients themselves and the claims representatives in the local field offices and the office of Disability Determination Services (DDS). Our patient support representatives will also meet with local offices for continued education and to stay updated on any changes that are issued by the Social Security Administration. A strong relationship with a claims representative at the field office means that we are not waiting in a line of automated options, but are able to speak directly to the local field office representative and the DDS examiner when we call for updates. Our close relationships allow our team to avoid costly delays in processing claims, but also ensure that our patients are aware that they are working with someone who genuinely cares about their claim and well-being.   

Our goal is to provide the best service to patients and to the hospital providers that we partner with.  We are able to do this because we genuinely care about each and every one of these claims and treat them as if they were our own family members.  When choosing a vendor to partner with, it is imperative that they not only protect your bottom line, but also the livelihood of those individuals seeking approval for their disability claims.  With RCA, your patients are never just a number.

With over 25 years of experience, RCA has become the go to Self-Pay Eligibility partner for many hospital organizations. Our expertise is unmatched and our commitment to provide the best service in the industry remains true today just as it did the day we were founded.

Over the years, we have developed processes and relationships that have helped our client partners reduce their A/R days. One of the ways we do this is by collaborating with the system’s case management department to develop solutions in order to get their patients out the door while still providing them with the best care and attention possible. When it is deemed necessary for a patient to require outside placement or receive additional care once they leave the hospital, case management reaches out to RCA and requests that we assist these patients by reviewing all Medicaid and SSI/SSDI solutions.

We are truly compassionate and want the very best for our client partners and their patients. Below are a few things that we do to maintain strong trusting relationships with case management and their patients that set us apart from our competitors.

Relationships

We maintain strong relationships with Medicaid and Social Security offices and meet on a routine basis to address any questions, concerns, or changes to programs. These relationships allow us to communicate directly to individual personnel rather than going through a call center, resulting in quicker application processing times and better communication.

Education

RCA stays up to date on all state and federal programs to ensure we are at the forefront of changes in the industry. We routinely meet with case management to discuss our processes, provide education and share updates, allowing us to best fit the needs of our patients and client partners.

Daily Follow Up

RCA monitor’s all Inpatient accounts daily, allowing us to monitor their condition, obtain documents, meet with patients and their families and acquire any new updates that may affect their ability to be discharged.  We provide updates to case management with any updates regarding their application statuses that may be useful during the discharge planning process.

Prompt Communication

Once we receive a referral from hospital case management, we immediately attempt to screen a patient (or their family members) to determine their eligibility for a program of assistance. Once a determination is made, we update the hospital EHR and case management. In addition to our initial screening outcomes, we communicate with case management about documents that we need assistance in obtaining from a patient or their family in order for their application to be processed.

Discharge Planning

The moment an agency determination is obtained, it is communicated to case management so that they can work on getting that patient discharged.  These daily updates on a patient’s case allows case management to make changes to a plan of action for quicker discharge.

These are just a few ways that RCA’s collaboration with Case Management and state/federal agencies allows for quicker application processing times, ensuring more timely patient discharges and ultimately reducing A/R days. At RCA, we strive to stay in front of changes and forging long-lasting relationships with our partners.

RCA is a Leader in the Third Party Eligibility and Third Party Liens Industry, but we did not get there by chance.  It starts by going above and beyond and thinking outside of the box when it comes to the traditional eligibility process. Below are just a few things we offer that allows us to deliver next level service.

Skip Tracing

For patients RCA has been unable to make contact with due to unreachable telephone numbers and/or returned or unanswered mail, staff will send the patient’s information through a skip tracing system that searches for new information. Utilizing one of the largest data linking technologies, RCA’s skip traces produce the most reliable and accurate right party contact information for patients.

Field Visits

RCA regularly conducts home, institutional and other field visits to ensure the eligibility and follow-up process is completely successful. Patient accounts that are non-responsive, high dollar or need extra attention will be scheduled for a field visit to ensure every effort is made on the account.

Transportation Services

Lack of transportation is seen as one of the largest obstacles in patient compliance. For patients who need assistance in attending agency appointments, consultative exams or disability hearings, RCA will provide local transportation, via taxi or rideshare services, at no cost to the patient or hospital.

Document procurement

Another challenge we see in patient compliance is the lack of proper documentation to allow for applications to be processed. For patients missing crucial documents such as birth certificates, identification cards or Social Security cards, RCA will assist the patient in obtaining these documents, at no cost to the patient or hospital.

RCA Patient Portal (Mobile App)

RCA developed a HIPAA compliant patient portal as an additional tool for patients to quickly and securely submit their personal documents, receive notifications and stay updated on their application status. Increasing compliance and reducing the time to receive needed documentation allows for faster approvals which in turn leads to quicker reimbursements to our hospital clients.

Patient Self-Screening Portal

Remaining relevant in today’s technology driven world, RCA created a Patient Quick Screen link on our website where patients can securely enter information pertaining to their potential eligibility for assistance programs. Once completed, this self-screening is directly uploaded into the patient’s account in RCA’s SECURE database for staff to review and determine next steps.

– Rod Thigpen, Regional Vice President

Healthcare is still relationship driven and patient experience has become an important factor in the care of people.  The definition of patient experience as defined by Wikipedia describes an individual’s experience of illness/injury and how healthcare treats them.  Increasing focus on patient experience is part of a move toward today’s patient-centered care.  This includes the range of interactions that patients have with the health care system.  Much of what we do today is technology based, and while there is still room for technology in healthcare, ultimately  we are working with people.

People who are not feeling well, who are getting bad news about their health, and who have family that are worried about their well-being.  Technology has a place in healthcare, but when you are working with people—they still want the personal touch.  They still need a positive patient experience.  Each partner that works within hospitals should have the same goal for your patient.

How can you keep the personal touch in healthcare?  The word is embedded in the title of our profession: CARE.  This is one of the biggest reasons why RCA has taken a different approach to eligibility.  A personal approach that demonstrates to the patient that we care.  While onsite, RCA takes the time to visit with the patient face to face.  Our employees are trained on communicating caring in a patient room.

While in house, we visit with the patient daily.  Some patients do not get visitors, so we ensure that each of our patients see a friendly face on a daily basis.  We are not there to talk business each day.  Some days we are there to see how they are doing and if we can do anything for them.  It is the relationship building while the patient is in house, that helps us stay connected when they are discharged.

When you are looking for a partner for third party eligibility, make sure you are looking for a partner who cares for your community and your patient.  That is going to be the best decision you can make.

-Bethany Bailey, Regional Vice President

Over the course of our 25-year history, RCA has built and maintained incredible relationships with our client partners, their staff and patients.  These relationships have become deep-rooted because we value our partners, their vision and mission, and the causes that they are passionate about.  Accordingly, we have made it a top priority to work closely with our partners’ staff offering insight and education on topics where our expertise is unmatched in the industry.  This helps to increase patient compliance and to ensure our management is continuously visible.

At RCA, we know that sometimes our services will be replacing another vendor, but we also understand that you may have your own in-house service team working on accounts.  In these situations, it is our goal to work alongside your employees assisting them to increase your bottom line in the most efficient way possible.  The goal is to enhance your system, not derail the work.  We establish our processes within your revenue cycle, working in tandem with your staff to find more eligible accounts, leading to an increase in reimbursements.

In order to maintain strong client partner relationships, we understand that staying at the forefront of technology developments as well as changes to regulations affecting eligibility is of the utmost importance.  This is accomplished by utilizing our long-standing relationships with local, state and federal agencies to be alerted to any upcoming changes.  This information is then passed along to our partners and their staff through educational webinars, lunch-n-learns and/or training presentations.  As we grow in knowledge you should too, and that should be a priority in the relationship with your vendor.

We realize that the relationship with our business partners includes their patient population as well.  Our goal is to maintain relationships with patients in an effort to increase patient compliance, potentially shortening A/R days.  In order to accomplish this, we have developed HIPAA compliant solutions like our online patient portal, a mobile app that allows patients to safely and securely upload documentation that may be necessary to complete their applications.  In addition, we have also created an online self-screening tool for patients to complete initial screening questions to help assist us in determining their eligibility for assistance.

Lastly, to continue to show the value of our relationship, RCA prioritizes monthly meetings with our clients.  We see this as a great opportunity for open communication between the facility and RCA management to address performance and identify issues immediately to ensure further problems are not encountered.  Our clients are always impressed by our ability to respond to all requests in less than 24 hours.  Finally, we also can participate in any routine high dollar / high volume case review meetings to provide needed updates on profiled cases.  Our in-house staff is available to hospital personnel at all times should they have any questions or need any additional information as well.

RCA’s success over the last 25 years could not be achieved without a commitment to these relationships benefiting both parties.  RCA continually seeks to provide that level of relationship with each and every one of our client partners.

As time approaches another Open Enrollment for the Healthcare Exchange, hospitals are reminded of the many people still uninsured who, even though they are eligible, are not utilizing the Healthcare Exchange.

Who is still uninsured?
Statistics show that 15 million men are uninsured in this country, half of which were non-elderly adults. Nearly a third of those uninsured reported having trouble paying medical bills and 4 out of 10 uninsured men are now eligible to receive coverage through the ACA Healthcare Exchange. So why is this group not participating in the Healthcare Exchange? Researchers have polled this population and have found them to be skeptical about engaging with government programs due to lack of information about availability, the perceived difficulty of the application process and exclusion to Medicaid prior to the ACA expansion in some states.

Another significant demographic that is not participating in the Healthcare Exchange are those aging off other insurance options such as Medicaid or their parent’s insurance plans. According to reports, only half of these young adults leaving their parent’s plan are buying insurance for themselves through the Exchange. This is likely due to the high insurance premiums offered by the plans.

As a hospital, what can you do to successfully reach those people and increase participation?
You and your local CAC’s or Navigator Organization can begin outreach efforts in community locations such as college campuses, churches, barber shops, extension centers and libraries. In addition, organizations can also reach out to small business organizations and job placement centers to have information available to the people they assist. In a concerted effort to reach the younger population, hospitals can join in the outreach that has begun via email and partnerships with companies that are widely used by the younger population such as Lyft and Uber.

Why is targeting these groups critical to you as a healthcare organization?
Because 68% of the eligible people in these groups have very few health risks, their participation in the healthcare exchange by obtaining insurance decreases the risk pool, thus decreasing the cost of healthcare.

Kary Wallace, Director of Training and Compliance

The topic of rising deductibles that have come along with the implementation of the ACA is hard to avoid these days. In a report put out by the Kaiser Family Foundation, the average deductible is more than triple what it was a decade ago, which is seven times faster growth than wages have risen in this same period. With such a rapid increase in deductibles, many patients are left a steep and unrealistic amount of hospital fees that they simply cannot pay. We have advised and consulted on this matter quite a bit recently and have determined that this influx of unpaid deductibles going to bad debt or charity is an increased pain point for hospitals and should be addressed similarly to other self-pay accounts.

The good news is that there are recovery solutions that hospital facilities probably already have in place that will certainly help recover some of those at-risk dollars. More than likely, those patients with high out-of-pocket expenses are first time insurance holders who may be in need of more information regarding the aspects of their plan and what is and is not their responsibility to pay. We recommend simply expanding the scope of which your financial counselors are working these accounts. Beyond payment plans, discounts and charity applications, Financial Counselors can be providing much needed education to your patients to help them better understand their bills, the breakdown of financial responsibility and the insurance process. If you have a vendor onsite that provides certified application assistance or ACA Navigator services, ask them to assist with providing educational materials or community outreach activities that assist with relaying this information to your community as well. In addition, you and your financial counselors can begin “front loading” your collections efforts for patients with pre-scheduled services. By arranging payments ahead of the service time, you can offer these patients “prepay” discount’s to ensure you are getting a portion of the patient’s responsibility upfront. “Front loading” can also work in situations where patients have limited plan coverage and need additional program assistance screening from your eligibility vendor.

Certified Application Counselors for the 

Over the past three years, RCA has embraced changes that the Affordable 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 education and assistance to our hospital client patients and general public enrolling in the healthcare exchange. Our clients turn to us with questions 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 important than it is at this point in time.