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If a patient becomes upset about the amount he or she will owe, Joseph Ianelli, senior financial manager of Boston-based Massachusetts General Hospital's admitting department, says that the message patient access staff want to give is: "There is something we can do for you. We want you to get the medical care you need."
About five years ago, the department integrated registration with financial counseling as part of a major redesign of front-end operations. "It made sense to start consolidating those roles," says Ianelli. "It's a higher job grade, and a more sophisticated approach that we are using. We have to look for people who have the skills to do both."
If a patient is having problems with eligibility at registration, he or she can start a financial counseling process, right then and there.
"Nobody has to wait in line all over again. They don't have to figure out where to go or what else to do," says Ianelli. "Staff members 'own' a caseload, and we have a database that tracks that. As long as a patient is cooperating and communicating, we will do whatever we can for them."
Process starts earlier
If the scheduling secretary puts into his or her system that a patient is uninsured, that piece of information gets to patient access staff right away. "We don't have to wait until the patient comes in to start the financial counseling process. We can start the process five or six days before they walk in for their appointment," says Ianelli.
A patient might be asked to bring in certain documents, or to go see patient access right before the appointment, and staff will finish up the process in the meantime. "Our patients need to focus on medical care and getting better," says Ianelli. "So staff are really held responsible for making sure those applications either get approved or legitimately not approved because they don't qualify for the program."
Financial counselors are expected to know the full range of options for patients. This includes understanding the internal policies and procedures of the hospital for discounting and payment plans. Or, it may be that there is some type of insurance coverage that the patient has access to but is unaware of.
"If there is a couple and the husband has insurance, why isn't the wife on it? It could be time for a conversation about the next open enrollment period," says Ianelli. "Or if someone has Medicare A, why don't they have Medicare B? Or if prescriptions are a problem, somebody may qualify for Medicare D."
An escalation process is used for difficult cases, such as patients with very large debt who don't qualify for public benefits or charity. "No hospital should want any of their patients to become destitute because of their need for medical services," says Ianelli. "It tends not to work that way; but it if does, I will raise the issue to upper-level administration with a full write-up and analysis."
At that point, a discussion can be held about what exactly can be done for the patient. A range of options is identified. The payment plan might be extended beyond the standard as part of an individual consideration due to financial hardship, for example.
"We start to talk about what would be reasonable this one time, on a case-by-case basis. But decisions are made based only on financial hardship. Otherwise, you run into some tricky compliance issues," says Ianelli. "You always want to do things completely above board. You can't have special arrangements for one person that you don't make for everybody."
Still, there is a great deal that can be done for individual patients. A woman in her 70s who worked for the state had a number of different insurances. She couldn't comprehend her coverage, such as why the secondary insurance wasn't picking up certain bills. After many unresolved phone calls to customer service, the situation was escalated to Ianelli.
"For some reason, the folks she was interacting with couldn't make any headway with her," says Ianelli. "So over the next six months, she and I worked together to understand her insurance and her bills going back for many years, and I was happy to do it. It's really all about developing a continuum of relationships from front to back, and working together to support the patient."