Even with programs that protect providers from uninsured patients, the costs of caring for those without healthcare coverage continues to put substantial financial stress on community hospitals.
Between 2017 and 2019, the number of uninsured nonelderly Americans increased by 8.5 percent. With the pandemic causing higher unemployment rates, the number of uninsured nonelderly patients is likely to continue to grow. Magnifying this problem for community hospitals are the lower health insurance coverage rates for America’s rural populations.
Regardless of how the members of your community became uninsured, they need care, and you need reimbursements.
What can a community hospital do to make sure caring for uninsured patients doesn’t put them in the red?
To find out, we sat down with Tyler Houston, a Strategic Account Executive for Revenue Cycle Management (RCM) services here at MEDHOST, who has over a decade of experience in healthcare finance.
Q: What kinds of challenges do uninsured/underinsured patients present to community hospitals?
Public-funded revenue protections for community hospitals only cover a portion of their costs and do not consider the additional effort required to make collections.
Often the community hospitals we work with don’t have the staff or time to spend hours collecting full payments. Regardless of the source of revenue, managing uninsured claims takes time and cost. Revenue loss impacts multiple areas of a facility and may force a cut in services.
Q: What role, if any, should hospitals play in pointing uninsured patients to coverage options?
Hospitals, especially those at the community level, should assist community members in finding health insurance coverage. Converting patients from self-pay to insurance coverage relieves the burden for both patients and providers.
Helping patients find coverage might create more work for your front office, but the payoff dramatically outweighs the investment. It is a matter of resources. In most cases, a third-party RCM vendor can provide resources on a successful basis. The MEDHOST RCM team is always ready to help our partners with advice and resources for these types of situations.
Q: If hospitals are tasked with helping patients find coverage, who is responsible for that task, and how will it impact their other duties?
Generally, hospitals have a Business Office staff member responsible for providing financial counseling. These professionals—often referred to as “patient navigators”—can assist in exploring various sources of screening and coverage. They can also help educate patients on the financial implications for their medical treatment and what coverages may be suitable.
Hospitals can also sponsor employees to become Certified Application Counselors. Additionally, some hospitals enlist the assistance of a Medicaid eligibility vendor to transition self-pay accounts to Medicaid.
Q: What kind of policy changes or services can hospitals adopt for uninsured patients, and what are some best practices on effecting these policies?
Helping a patient find the best form of coverage for their situation is usually the best approach. However, any method that enables payment collection at point-of-service will significantly improve a hospital's collection efforts.
The most common option is building standardized payment plans. When a facility proposes these plans, it must also provide a clear payment policy and schedule.
Hospitals should also consider various methods of collecting receivables after treatment. These methods include online billing and payments, time pay, and auto-draft.
When explaining payment policies or options to uninsured patients, community hospitals should equip front office personnel with scripts. Scripts act as guides that help front office personnel display empathy while still making clear the timetables and the patient’s financial obligations.
Managing uninsured patients will continue to be a challenge for healthcare providers, especially at the community level. If your facility needs help collecting from uninsured patients or needs support managing a dynamic revenue cycle management process, please reach out to us at email@example.com or call 1.800.383.6278.