PFS Strategies for 2014!

The only certainty of “Obamacare” is that there will continue to be uncertainty as this Administration concocts rules as time goes along. One fact remains true; the “uninsured” continue to grow. Whether it’s because they lost their healthcare coverage due to ACA or because the lackluster economy hasn’t provided the work opportunities to secure coverage, we as healthcare providers will still have to “make do.”

What does “make do” mean for healthcare providers? I’ve always advised my clients and prospects that diligence is the ultimate key to financial survival. From a Patient Financial Services point of view, this means that providers must continue to take proactive steps to address the self-pay population knocking on their doors.

Here are a few key considerations when practicing diligence:

Patient Access/Financial Counselors – Must take a proactive role in determining their patient’s ability to pay

  • Become intimately knowledgeable of available financial assistance programs; not just the Health Exchange Programs and Medicaid
  • Must thoroughly screen patients to determine linkage to those programs
  • Diligently and expeditiously assist patients in completing funding applications (in place of ACA-Online access)
  • Establish a means to assist patients in procuring documents and verifications (i.e. income statements, birth certificate, etc.) and transportation
  • Communicate with Funding Agencies regarding status of their patient’s cases
  • Notify the patient of outcomes (this increases patient experience, facilitates follow up visits)

Utilize your Eligibility Vendor and develop enrollment goals

  • Eligibility Vendors are uniquely suited to this role
  • Eligibility Vendors are already certified or seeking Certified Enrollment Counselor/Entity status (if not find another vendor)
  • Eligibility Vendors are currently or preparing to conduct ACA/Exchange enrollments
  • Develop eligibility and enrollment goals with your vendor. This is a must. Do not leave it to the vendor to determine these goals. Goals should be challenging, but realistic and based on past performance, demographics and volume. Keeping a vendor just because you like the vendor’s on-site representative does not signify success!

If you do not currently use an Eligibility Vendor – Consider speaking to the many out there..  Here are some Vendor Considerations –

  • Patient Philosophy – Your vendor must ensure the needs of the patient come first and foremost
  • Technology – Does the vendor have the technological tools to best serve you and report what they’ve done? Do they use tablets for their patient screening? Do they have software that manages their time and ensures account handling efficiency? Do they use document scanning tools to make it convenient for patients? Do they offer integrity in reporting? (No carve outs!) Do they track how many patients were screened within the first 24 hours? Are they concerned about patient wait times?
  • Workflow/Account Handling Process – Does the vendor have an efficient workflow process, considerate of time-based deadlines? Is their process considerate of your AR days and goals? What kind of things do they do to compress the application cycle?

2014 is shaping up to be a doozy! The only things you can do is be flexible and diligent. Take these simple suggestions and incorporate them into your strategy. Regardless of what ACA brings in 2014, these suggestions will never go out of style and will always be relevant.

Written by: Sherman “Sonny” Gardner, President & CEO of Gardner Group Inc. A leading provider of patient financial assistance and enrollment services for healthcare providers. (800) 401-4060;