Eligibility Management: First and Lasting Impressions with your Patients

In our previous post, Eligibility Management: Who are the Uninsured and Underinsured?, we set the stage for how the face of today’s un- and underinsured patient population is changing.

Today we’d like to offer some key eligibility management considerations.

First, as we’ve said before, the face of eligibility management has changed over the past few years. Candidates now include more and more children and the traditionally insured, in addition to the homeless and the disabled. Most of these folks are in stressful situations and caring assistance is what they need most during these difficult times.

It’s also important to realize that the first and last person these patients deal with is not a clinician—it’s a member of your revenue cycle team. Which means you’re trusting the initial and final patient impression to an employee whose primary role has more to do with your bottom line than actual patient care. Make sure these team members are the right, highly educated and compassionate people for the job with the training necessary to help the patient resolve the account.

Also remember that there are a lot of potential touch points with every patient in between that initial encounter and the final contact at discharge. It’s important that you maintain a focus on quality throughout the entire process, with regular communication informing and educating patients about their care options and the government programs that are available to them and applicable to their situations.

Finally, remember that your revenue cycle objectives and your patient care goals are not mutually exclusive when it comes to eligibility management. Helping patients navigate through the complex world of the government assistance programs available to them is compassionate care, pure and simple. And it’s also directly related to your financial performance.

Connecting those in need with programs such as Medicare and Medicaid ensures that your organization will receive the payments it deserves for the patient care you’re delivering to this expanding patient population. While some caregivers might feel uncomfortable connecting patient care so closely with revenue, the truth is that your organization owes it to your patients to remain financially viable so you can continue to deliver quality care.

In a subsequent blog, we’ll take a closer look at quality assurance and quality improvement measures as they apply to your eligibility management approach, and consider the importance of taking those a step further to include qualitative and quantitative management. We’ll also examine Lean principles, and how what started as an automobile manufacturing process improvement methodology has made its way into healthcare.

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About Kent Smith

Kent Smith

Kent leads MediRevv’s new business sales initiatives and marketing and account management programs. He has built, from the ground up, a cohesive team of healthcare sales and marketing professionals who understand the critical aspects of any engagement: exceeding the expectations of and creating value for our clients; building enduring, mutually beneficial partnerships; and maintaining transparency and a high level of trust in our execution.

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