University of Louisville Hospital

Size: px

Start display at page:

Download "University of Louisville Hospital"

Emory Eaton
7 years ago
Views:

1 University of Louisville Hospital A case history of obtaining government reimbursement for charges of self-pay patients. Our unique vision has made us the leading provider of comprehensive patient eligibility services to America s hospitals

2 Background Across the country, hospitals are striving to plug up a huge drain in their revenue: charges uncollected from patients who lack insurance. For example, at the University of Louisville Hospital (University Hospital), 30% of in-patients don t have insurance coverage, and approximately 23% of their charges will end up as bad debt. To get potential bad debts shifted into paid categories, many hospitals screen their patients to see which cases are eligible for reimbursements from government-subsidized programs. Medicaid, Medicare, Social Security and disability, as well as state and community-funded programs, are possible payers. However, getting a patient qualified for reimbursement funds is a perilous path. Hospitals try to help patients cope with lengthy, cumbersome application processes ridden with delays and denials. But most hospitals simply lack the resources and the expertise to keep track of every application through a process that usually takes months. Consequently, of all patients who should qualify for reimbursement programs, a substantial percentage of them never gain approval. University Hospital faced this situation in 2001 and found a solution. University Hospital Snapshot University of Louisville Hospital Louisville, KY Problem: Solution: Results: (3/ /2010) Projected ongoing benefits: Major teaching hospital and Level 1 trauma center 404 licensed beds 441 registered nurses 15,300 admissions in 2009 Many charges for self-pay patients are not collected due to ineffective process of qualifying charity and uninsured cases for government-funded programs Chamberlin Edmonds retained to serve as patient advocate in applying for government assistance Accepted more than 26,000 patients for benefit applications Over 18,600 cases approved Over $704 million in gross charges approved Recovered more than $132 million in cash to the hospital More than $20 million cash recovery per year ongoing 2

3 A better way to find money In March of 2001 Bob Barbier, just brought in as University Hospital s chief financial officer, introduced his colleagues to a solution he discovered three years earlier while serving as chief financial officer at Grady Memorial Hospital in Atlanta. Grady was an inter-city teaching facility. I met the founder of Chamberlin Edmonds, who explained their approach to finding money from uncollectible accounts, Barbier explains. Grady was able to bring in Chamberlin Edmonds, and things really took off. When he arrived at University Hospital, Barbier found that his new employer, too, needed a strong program to help get government funding for qualified disabled patients. His recommendation to bring in Chamberlin Edmonds received immediate approval. Basically, we had been trying to kick over the rocks and find money, Barbier said. But healthcare is not a simple business. If you extend the complexity of getting just one disability case approved across the full scope of what goes on in a hospital, it s easy to see why you can t do it all internally. Vigorous follow-up turns applications into cash Initially, some were skeptical that an outside firm could achieve better results. However, it didn t take long to see that the volume of applications, as well as incoming money, was increasing. Hospital staffers responsible for screening cases had a maze of other duties, said Pat Borromeo, Director of Admissions and Registration. We felt that Chamberlin Edmonds, with its concentrated focus and dedicated people, would help and they did. They collected a lot more than we initially expected. Chamberlin Edmonds quickly streamlined processes and learned where applications were getting sidetracked. For example, when the team discovered that some Hispanic ob-gyn patients were not getting verification for Medicaid, a Chamberlin Edmonds representative established special procedures to solve the problem. We do a lot of extra things, said Edie Dearfield, the Chamberlin Edmonds regional vice president of operations. They have embraced us as part of the hospital s staff. 3

4 Many of the cases involve substantial potential reimbursements. Dearfield recalls one instance of an elderly patient who should have qualified for Medicare but wouldn t talk to anyone. Nearing death, the patient lapsed into and out of comas. Chamberlin Edmonds representatives managed to get enough information from him to complete a Medicare application, resulting in the collection of $367,000. According to Borromeo, having specialists involved in screening patients and helping them submit applications is just the beginning. Without a meticulous follow up process by full-time patient representatives, a case can easily fall through the cracks. She gives Chamberlin Edmonds high marks for attention to detail, accuracy and responsiveness. I work personally with the Chamberlin Edmonds people. They are all very courteous, professional and responsive. If there s any way they can help, they will. They re good about keeping the caseworkers and social workers up to date. And their bills are correct they don t try to invoice for cases they didn t handle. Billing accuracy has been an issue with some other vendors that search for reimbursements, Borromeo said. She has to methodically check records to catch items that should not be invoiced, a process that takes a lot of her time. Since it began accepting applications at University Hospital, Chamberlin Edmonds has been responsible for recovering more than $132 million in cash to the hospital. According to John Nord, the hospital s business office director, Chamberlin Edmonds has been increasing staff to handle increased volume. The goal is $20 million this year, and probably 10% more next year. Chamberlin Edmonds has always served us with very professional employees, said Nord. They work well with our patients and our staff. Bob Barbier concurs. It s been a very positive relationship, he said. Chamberlin Edmonds excels in working with patients and using a comprehensive approach that gets results. 4

5 About Chamberlin Edmonds Headquartered in Atlanta, Georgia, Chamberlin Edmonds serves as patient advocates and provides custom-tailored eligibility services to hospitals nationwide. Our comprehensive services examine the widest spectrum of uninsured and underinsured patients, including inpatient, outpatient and emergency department cases. The advanced technology of our proprietary web-based system is built on the unique experience and expertise of the most qualified eligibility and enrollment professionals in the industry our people. Chamberlin Edmonds has over 25 years of experience in eligibility services, with eight regional offices in the U.S. Please visit to learn more. Medicaid Eligibility (Inpatient, Outpatient, ED) Social Security Disability - SSDIB Supplemental Security Income - SSI State Disability Charity Care Crime Victims Assistance FB3945

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES Healthcare is complex. Getting paid shouldn t be. While we offer many solutions and services, they are all are designed to do just two things. Collect patient