By now, secondary eligibility has made a name for its self in the Hospital Revenue Cycle, but depending on your experience with this service there may be some mixed feelings about it. Typically, secondary Medicaid eligibility is used as a safety net behind primary vendors or in-house teams to maximize revenue recovery opportunities that may have been overlooked the first time. Some hospitals may choose a safety net vendor if they feel that their primary is under-performing or may opt out of this service if they feel that the eligibility team is surpassing conversion expectations. If your primary vendor is a lot to manage already, the thought of adding another vendor may seem cumbersome or you may fear it will cause interruption. The truth is that these assumptions are inaccurate for the most part, and there are several other factors to consider when determining if your hospital would benefit from a safety net service.

Safety net services are done completely behind the scene, are noninvasive to current processes and a contingency-based pricing schedule makes the recovery service risk-free. Because secondary cases are usually more difficult or are approaching deadlines, successful secondary vendors work referrals as thoroughly and rigorously as they would if they were the primary.

Do you feel like your Medicaid conversions should be higher? Has your third-party vendor become complacent on high or low dollar accounts? Are monthly reports leaving you uncertain about the data being received? A secondary vendor can ease those pains points by providing a closer look and offering expert advice.

If your hospital facility has more than 150 beds or a self-pay population of more than 10%, we strongly recommend a secondary eligibility vendor, regardless of the primary vendor’s performance. We have seen first-hand that adding some friendly competition to run eligibility behind the existing process can dramatically increase performance from all parties.

Bethany Bailey
Vice President and Eligibility Expert

For best results and timely reimbursements, follow-up needs to be rigorous and consistent. RCA has heard from multiple clients that their eligibility vendors failed to stay on top of accounts and the money eventually ran away from them. Noncompliance and difficult patients are pain points that are made easier through constant contact and account monitoring.

From the minute your uninsured patient leaves the hospital, the clock begins ticking and that revenue becomes harder to recover. In many cases, patients are hard to reach by phone, do not respond to mail correspondence and even the most thoroughly trained staff will struggle with gathering the much needed documentation for maximum reimbursement.

We’ve found that weekly communication to the case worker, agencies and the patient is critical to shortening the amount of A/R days to payment. In search of discharged patients, sometimes this consists of measures including home, jail and shelter visits, transportation to and from appointments, translations services and skip traces.

Bethany Bailey

Vice President of Operations

Losing self-pay dollars is not a fight you should walk away from. Whether your facility manages eligibility in-house or has partnered with a vendor, there are still parts that need monitoring to make sure you and your patients come out the winners.

We have been asked to perform hundreds of eligibility audits to determine if money is being left on the table; below are the biggest pain points we evaluate during a standard review.

Promptness of Inpatient screening – It is easy to assume the patient is being screened for government assistance before they leave the facility, but unfortunately that is not always the case. This is the first place our experts evaluate. To make a quick determination and build a relationship with the patient, your eligibility team needs to be doing screenings within 24 hours of admission.

Follow-up on account progression – It is very important to monitor self-pay accounts regularly. If we don’t see regular notes made in the hospital system regarding account progression, it’s a red flag that the current process may be hurting the bottom line.

Payment follow-up – Your eligibility vendor or in-house team needs to make payment follow-up a priority in the recovery process. We find billing and payment to be an easily missed task and a costly point in the revenue cycle. A successful eligibility process does not end with follow-up. The most important piece is ensuring the hospital receives payment.

Depending on the patient mix, self-pay numbers can range making it hard to determine exactly how much a hospital’s recovery should be. Typically, we’ve seen anywhere from 20-30% of self-pay populations qualify for assistance in non-expansion states and conversions rates on net placements between 91-96%. We suggest you take a closer look at the above-mentioned points of your eligibility process if your numbers seem lower than our expert advice.

Bethany Bailey
Vice President and Eligibility Expert