FAQ s for Revenue Cycle Management Vendors

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1 FAQ s for Revenue Cycle Management Vendors General Questions Q: Who is PointCarePA & what do you offer? A: PointCarePA is a team of health coverage experts who set out to organize a fragmented health care system. Our main product is PointCarePA, a 90-second, web-based screening, enrollment, and reporting technology designed to work in a variety of environments from fast-paced, high-pressure Emergency Rooms to community health fairs or clinic waiting rooms. Our screening technology searches a database containing Federal, State, County, Health Exchange, Individual plans, Subsidies, Charity, and Grant Programs several thousand programs and growing! Our goal is to accurately deliver instant health coverage options so patients nationwide can access funding for their health care, and so facilities providing care discover more reimbursement opportunities than ever before. With PointCarePA, you have organized and instant access to the entire United States health coverage system right at your fingertips. Q: What exactly is PointCarePA? A: PointCarePA is a web-based screening and enrollment automation technology that is customizable for each of your clients. There are 3 main modules within PointCarePA: 1. Through the screening module, hospitals will create a consistent, accurate, and fast screening process. Our database contains every application, enrollment checklist, and program contact information for ease of access. This will help hospitals reduce overhead and simplify training since PointCarePA s database is kept completely up-to-date with all program changes and is so comprehensive that it effectively makes anyone an instant expert in health coverage options. 2. Our automated enrollment technology queues each patient screened using PointCarePA into a patient profile ready for streamlined document collection at bedside. 3. PointCarePA s Dashboard provides anonymous, HIPAA-compliant reports containing data on demographics, income levels, family size, health conditions, staff performance and more. Dashboard reports allow for greater accountability and analysis of self-pay populations. Q: How will PointCarePA increase the value of our services to our hospital clientele and set us apart from other revenue cycle management vendors? A: The opportunities are truly endless, especially depending on how you package it. Here are just a few great ways: PointCarePA s 90-second screening solution simplifies and automates the screening process. A nice value added to be sure! PointCarePA s database includes all coverage options and is kept completely up-to-date for you. Reduce overhead and staff training! Queue up patient accounts using our enrollment automation technology so enrollment teams have instant access to screened patient accounts and can streamline document collection at bedside. A quick turnaround!

2 With PointCarePA, it s easy to screen all inpatient accounts, even if they have already been previously screened using a less robust solution than PointCarePA. Discover additional reimbursement opportunities! PointCarePA s technology is built to handle bulk account screening. Hospitals can easily queue up several thousand accounts for instant results. Increase efficiency! Is there a revenue gap where uninsured patients exist? Solve it with PointCarePA! See how Sharp HealthCare used PointCarePA to gain $5 million in revenue! Q: My process is currently manual and doesn t screen for all programs. How many programs does PointCarePA screen for and how long does it take? A: Let s break it down mathematically. There are roughly 3,200 counties in the US, all with a minimum 5 public programs. Thus, we are looking at over 16,000 programs, and PointCarePA screens for every program, every time in less than 90 seconds. Q: Does PointCarePA identify multiple opportunities for health coverage? Meaning will a patient be able to enroll in more than one program? A: PointCarePA identifies every program the patient may qualify for based on our simple 5-step screening process. As enrollment teams and patient advocates become more familiar with the programs over time, they will certainly learn when multiple opportunities exist to increase funding sources. We look to the advice and expertise of patient advocates using PointCarePA to help enhance our results so that we can automatically identify when these opportunities exist. Q: I ve noticed applications and programs tend to change often, which can be a hassle for an enrollment team. How often is PointCarePA updated? A: PointCarePA is updated in real-time as information changes. We have a large team of experts who are constantly updating our system. Our team also adjusts the database instantly as program changes are announced. For example, PCIP (Pre-Existing Condition Insurance Plan) closed enrollment on February 16, As soon as it was announced, PointCarePA s database was updated within minutes, and patient advocates all over the country were no longer presenting PCIP to their uninsured patients. In addition, we are also proud to say that patient advocates using PointCarePA assist with these real-time updates because they are in the field and experience enrollments first hand. Thus, real-time enrollment updates and eligibility changes are often provided from the ground up. Real-time updates and accurate results save you time and money by eliminating much of the ongoing training needed on your end to help patient advocates identify programs. Plus, you can be sure the results you give patients from PointCarePA are accurate. Q: How is PointCarePA able to help with the Affordable Care Act and enrolling patients? A: PointCarePA has included all available Health Exchange programs in our screening database, which became active on October 1, In addition, the 5-step screening process has been altered slightly to include questions about qualifying events after open enrollment ended. We include plan information, price, subsidy amounts, and applications. Additionally, PointCarePA s enrollment automation technology will make it easy for patient advocates to initiate the enrollment process, maintain documents, and follow up through completion. Q: How much does PointCarePA cost?

3 A: PointCarePA is offered as a monthly subscription. Additional fees may include PointCare Academy Training Courses and Facility Program Customization. For more details, please submit a Quote Request. You will also receive a free demo of PointCarePA when you submit the request. Q: How much experience and history does PointCare have? A: PointCarePA has successfully screened more than 600,000 patients as of May We ve learned from clients that there is a 60% conversion rate when being assisted by a patient advocate and a 42% conversion rate when patients apply independently. One community health center experienced a 72% conversion rate when using PointCarePA at outreach events and then following-up with enrollment. The conversion possibilities are endless! Q: How do patients access their screen results? A: The patient advocate can print the results or them to the patient right from PointCarePA. The includes links to all plans, applications, costs, and sign-up checklists. Q: Will the system work on an ipad? A: Yes, PointCarePA is web-based and will work on any computer or mobile device with an internet connection, including tablets such as ipads. This allows for greater mobility at bedside Q: Can we provide a link to PointCarePA on our site? A: Passive screening allows patients to come into a facility with prior information about their available health coverage options. Facilities can also provide a self-directed link to PointCarePA on their website for an extra charge. Q: How many hospitals are using PointCarePA? A: Currently, PointCarePA is being used in several California-based hospitals and clinics and is in the negotiation process with more than 50 hospitals throughout the country and hundreds of clinics. Sharp HealthCare has been using PointCarePA for 3.5 years and has helped more than 60,000 self-pay patients discover their health coverage options. Testimonial from Gerilynn Sevenikar, VP of Patient Financial Services at Sharp HealthCare: Most self-pay patients want to contribute toward their bill, but because of the laborious nature of qualifying for assistance on both the patient s and the hospital s end, they often had to give up and leave the hospital unfunded. PointCare helped to solve that problem. It s actually changing the mindset of my team that collects from self-pay patients. We work with them, hear their story, and do what s right as opposed to pushing patients into situations that make them feel uncomfortable. Q: Can we see a demo of PointCarePA? A: After an initial Webinar introduction to PointCarePA s screening services, we will create a PointCarePA Demo username and password for you and your team to try out so you can get to know the system. This demo expires two weeks after you receive it. The demo will allow you and your team to see how easily patient advocates will be able to assist patients with navigating the health coverage system and discover all of their health coverage options.

4 Q: Can hospitals do a trial? A: Discounted trials are offered on a case-by-case basis. An agreement would need to be signed, and it is required that you also purchase the PointCare Academy Training and Facility Program Customization to see the most benefit from using our program during this trial period. Q: How can hospitals use PointCarePA with less impact on IT? A: Hospitals can choose the stand-alone, non-integrated version of the tool. We would create an account for the hospital that can be used on any computer with internet access without having to integrate PointCarePA into their EMR system. Q: What do we do with patients who don t have computers? A: PointCarePA takes place within the Emergency Rooms on a hospital s computers and network. The 5 questions are meant to be asked at point-of-care and will produce a personalized list of health coverage options that can be printed and given directly to the patient at the hospital. The list includes program names, contact information, monthly costs, and sign-up checklists of important documents needed to enroll in all programs for which a patient may be eligible. Applications and online enrollment pages can be printed and given to the patient, along with their list of eligible programs, to support the conversation between the patient advocate and the patient about their responsibility to sign-up for health coverage to protect themselves and their community. Q: Are applications/assistance available in English and Spanish? A: PointCarePA is available in English, Spanish, Russian, Chinese, Vietnamese and Armenian using the Google Translate drop-down tool at the top of the page. Each patient s personalized list of health coverage options can also be translated using this function and printed or ed directly to the patient. We are currently adding languages to the list, so if there are other languages that reflect the needs of your constituency, we can work on adding them. Some of the programs listed with PointCarePA have applications available in Spanish and other languages, and some do not. It is best to check under the Program Details link for any additional applications not included in the Start Application feature. Q: Does PointCarePA bring in people/staff to sign-up patients or is that handled off-site? A: The value of PointCarePA is in the technology and its power to enable experienced and knowledgeable staff to screen for all health coverage programs instantly. Therefore, we do not bring in any additional staff to run PointCarePA. We can work with each facility to determine where PointCarePA will be most beneficial, whether during the admittance or outreach process. We also provide our PointCare Academy Trainings, which include topics on the uninsured, how to use PointCarePA, understanding available coverage options, and Health Care Reform in order to strengthen the knowledge of a facility s staff members. Q: What s the overhead investment for a process like this? A: The overhead investment is minimal. There would be no need to expand a current Patient Financial Services Department, as we would train the current personnel on how to use our simple service.

5 Q: What s the return on investment (ROI) if we were to go with PointCare? A: The ROI can be substantial and will continue to grow over time. Facilities will be able to identify more opportunities for reimbursement due to increasing the number of screens they are able to do in the same time period and by having access to a database containing all coverage options, including programs for which they do not currently screen. If a facility finds even one or two APR/DRG reimbursements per month as a result of the proper screening PointCarePA provides, they will have paid for its services and then some! PointCarePA Database Programs Q: What is the payer mix for a hospital that would reap the most benefit from PointCarePA? A: The payer that would bring the most benefit to patients and reimburse hospitals at the highest level is the guarantee issue private market. The following guarantee issue private plans are listed within PointCarePA: Individual Plans for Children under 19, Parent s Employer-Sponsored Coverage for Dependents under Age 26, Small Business Coverage (Self-employed, 2+EEs), COBRA/HIPAA continuation coverage. Your hospital and patients would also benefit from the retroactive programs listed within PointCarePA, such as: Medicaid, Social Security Disability Insurance, COBRA, and Victims of Crime Compensation Fund. Q: If a hospital is referring patients to private plans, aren t there premiums the patient will have to pay? A: Not necessarily. There are circumstances when the patient may not have a premium. For example, if the patient is a 23-year-old dependent and the parent s health coverage is completely paid by the employer under a family policy, then the 23-year-old can be added on to the plan without any additional monthly premiums. There are also premium assistance programs available that PointCarePA will identify, such as the Health Insurance Premium Payment Program (HIPP) and the Health Coverage Tax Credit (HCTC) Program. Q: What programs are retroactive? A: PointCarePA identifies the following retroactive programs for your patients: Medicaid, Social Security Disability Insurance (SSDI), COBRA/Mini-COBRA, Medicare Part D, and the Victims of Crime Compensation Fund. Q: How does PointCarePA help immigrants awaiting legal status? A: In some states, public programs are available to cover emergency services or other healthcare needs for immigrants awaiting legal status. For example, in Oregon, non-u.s. Citizens can enroll in Oregon s state-run high risk pool and in New York, the Medicaid program is available to cover emergency services for eligible immigrants. These programs, among others, will be presented in your patient s personalized list of health coverage options when appropriate. Dashboard Reporting Q: What type of reports can we expect from PointCarePA? A: Family Size, Income Level, Gender, Age, Coverage Eligibility, and more. Our current clients have found that PointCarePA s real-time Dashboard Reports are enabling them to get to know their self-pay

6 population on a greater level which helps to improve their patient-staff conversations and adjust your facility s environment appropriately. We can also break out your patients eligibility for public vs. private health coverage programs and plans, and, more specifically, help you to keep track of how many were found eligible for the new ACA-Exchange plans. Q: Where do you get data for reports? A: Each time a patient is taken through PointCarePA s five steps, a log is generated indicating the username of the staff member who screened the patient, along with the patient s answers and all of the coverage opportunities that were presented to the patient. These logs are used to create the reports. If you have additional questions about PointCarePA, please send them to us at PCPAinfo@pointcare.com.