University of Louisville Hospital

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University of Louisville Hospital A case history of obtaining government reimbursement for charges of self-pay patients A Chamberlin Edmonds Customer Success Story At a glance: Partner Company Name

1 University of Louisville Hospital A case history of obtaining government reimbursement for charges of self-pay patients A Chamberlin Edmonds Customer Success Story At a glance: Partner Company Name University of Louisville Health Care, Louisville, Kentucky Company Profile Main Campus: Louisville, Kentucky Major teaching hospital Operating Statistics 404 licensed beds 579 registered nurses 17,308 discharges in 2011 Key Challenge Many charges for self-pay patients are not collected due to ineffective processes of qualifying charity and uninsured cases for government-funded programs Key Achievements after Retaining Chamberlin Edmonds Accepted more than 35,538 patients for benefit applications Over $900 million in gross charges approved Recovered more than $176 million in cash to the hospital More than $20 million cash recovery per year ongoing SCREEN APPLY ENROLL

The Challenge Across the country, hospitals are striving to plug up a huge drain in their revenue: charges uncollected from patients who lack insurance.

2 The Challenge 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 percent of inpatients don t have insurance coverage, and approximately 23 percent of their charges will end up as bad debt. To get potential bad debt shifted into paid categories, many hospitals screen their patients to see which cases are eligible for reimbursement from governmentsubsidized programs. Medicaid, Medicare, federal 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. Chamberlin Edmonds has always served us with very professional employees. They work well with our patients and our staff. - John Nord, Business Office Director

3 The Process to a Decision 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.

4 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. 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. - Pat Borromeo, Director of Admissions and Registration We do a lot of extra things, said Scott Swartz, the Chamberlin Edmonds regional Vice President of Operations. They have embraced us as part of the hospital s staff. Many of the cases involve substantial potential reimbursements. Swartz recalls one instance of a patient who should have qualified for Medicaid 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 Medicaid 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 $176 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 percent more next year. Chamberlin Edmonds has always served us with very professional employees, said Nord. They work well with our patients and our staff.

5 About Chamberlin Edmonds Chamberlin Edmonds, an Emdeon company, serves as a patient advocate and provides custom-tailored eligibility and enrollment services to hospitals nationwide. Our comprehensive services examine a wide spectrum of uninsured and underinsured patients, including inpatient, outpatient and emergency department cases. Emdeon is the leading provider of intelligent revenue cycle solutions that combine advanced technology with highly trained professionals, enabling hospitals and health systems to maximize revenue and profitability. With growing bad debt and increasing pressure on reimbursement rates, our full suite of solutions and technology-enabled services help ensure healthcare businesses succeed. 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 Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the U.S. healthcare system. To learn more, visit our website at SCREEN APPLY ENROLL 2013 Chamberlin Edmonds. All rights reserved. CEAA rev Piedmont Center NE Suite 800 Atlanta, GA

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