Does your Revenue Cycle Include Community Outreach?
For years, the revenue cycle has consisted of the same components; scheduling, registration, authorizations, financial counseling, coding, medical records, billing, and collections. It has focused on patients who have been in the hospital. The patient/provider relationship started when the patient called to schedule a procedure or presented at the hospital for walk in or emergency services. The revenue cycle essentially “waited” for an individual to become a patient then inquired about insurance coverage and helped those without it qualify for coverage such as Medicaid or other governmental programs. But why wait? Why not establish a relationship with the community in which the hospital reaches out to community residents, prior to them becoming a patient, to help those that do not have health insurance find coverage?
A community outreach program is a proactive approach that can be taken by the hospital to identify those individuals without health insurance and see if they have qualifications that would make them eligible for Medicaid or other health insurance coverage. Equipped with laptops or iPads, dedicated staff trained in Medicaid eligibility, go out into the community to provide education on Medicaid, screen for qualifications, and facilitate the application process. The outreach program can be staffed by employees of the hospital, usually financial counselors, or employees from a contracted Medicaid eligibility vendor that the hospital uses.
Partner with the Community
So how does the outreach staff know where to go? Partnering with other organizations in the community, who serve the same population that the hospital is trying to reach, allows for easy access to these community residents. Schools, churches, libraries, sharing centers, and other not-for-profit agencies that service low income families and children are most ideal to partner with. These organizations usually have meetings or events already planned that the hospital can “tag along” and participate in. By combining efforts with community partners, it takes the burden off of the community residents, in that they do not have to attend another meeting or event, the hospital goes to them.
It’s a Win-Win
An outreach program changes the way of thinking for the traditional revenue cycle. Now, instead of “waiting” for the patient to come to the hospital, the provider relationship is started with a “potential” patient before the community resident even goes to the hospital. This is a win-win for both the hospital and community. The community residents are provided the opportunity to obtain insurance and can now secure a primary care physician and/or prescription drugs that they could not afford before. With Medicaid, these “potential” patients now have insurance coverage when they do need hospital services and the hospital has a payor source they can bill for reimbursement.
Positive Impact on Revenue
Proactively reaching out to those individuals in the community that do not have insurance and qualifying them for Medicaid or other insurance coverage is essentially a “self-pay conversion”. When those “potential” patients, who obtained Medicaid through the outreach program, become patients they have insurance that the hospital can bill day one and not have to wait days, sometimes months, for the self-pay conversion. Therefore, an outreach program, as a component of the revenue cycle, positively impacts the cash flow of the hospital by speeding up the self-pay conversion process. It’s time to reach out!