Our Solutions: Eligibility and Patient Services

 

Real Time Eligibility:

A quick solution with online confirmation of patient insurance and benefit coverage directly from the payers’ database (including Medicare, Medicaid, Commercial Payers).

Benefits:

• Reduce claim errors and bad debt
• Increase patient and employee satisfaction
• Accelerate cash flow by allowing immediate collection of patient share of cost and/or deductibles
• Provide extended credit options for any treatment that is not covered by insurance

ESI employs an effective solution, geared towards the self-pay population, that allows each patient to be evaluated for their ability to pay based on their credit score and admitting diagnosis, including eligibility for state, federal or local programs, and eligibility for charity care and indigent population programs. This program minimizes the challenges of charity care and up-front bad debt/contractual issues.

Pre-Service Data Validation Services is a trio of services that provides quick, online confirmation of patient demographic information and the patient’s ability to pay. Collecting accurate patient data before services are performed is critical to maximizing payments and minimizing collection costs.

With Pre-Service Data Validation services from ESI, you can ascertain needed information more easily, quickly and from a central location. Using standard secure technology, immediate access is provided to the most accurate data available on patient demographic information as well as the unique risk assessment tool.

Payment Evaluator reduces write-offs and denials by quickly assessing the patient’s ability to pay at the point of service. We offer many instant credit options for patients having large deductibles as well as the self-pay population. The Payment Evaluator verifies patient demographic information and checks the patient’s credit coupled with the reason for admission and then uses this information to assign the patient into a user-defined financial class and probable payment categories. 

Charity Care Program streamlines the administrative processes for uninsured and under-insured patients. This program identifies patients that may qualify for charity care or uninsured discounts in compliance with your existing credit and collection policies utilizing qualification forms, Charity Care, Self-Pay, and Underinsured for work lists for those that qualify, reconciliation reports and follow-up on patient populations for additional eligibility services.

State, Federal and Local Eligibility Evaluator identifies patients who are likely to qualify for a State, Federal or locally funded health services program (e.g., Medicaid, SSI Disability, VOC, Tobacco Tax, 1011, CHIPS, and many other local and state designed programs) based on current regulations. ESI utilizes our proprietary scanning system along with pre-qualification forms to help simplify patient screening processes and language barriers. ESI’s evaluation process is accessible 24/7 even when facility patient advocates and utilization management staff may not always be available to help patients. Work lists for identification and documentation of those that qualify are provided along with reconciliation reports to track and follow-up on this patient population. ESI offers a unique relationship with many of the state programs that allow ESI to run queries against the state systems to verify previous application status indicators, dates and other key approval notifications.

Eligibility and Patient Services solutions allow healthcare organizations to improve their financial performance by validating patient demographic data and performing risk assessments. With pre-service validation services, you can:

• Reduce denials, bad debt, and lost revenue by verifying demographic information and facilitating the probability for payment before providing services
• Improve patient and community relations with non-biased and automated charity workflow processes
• Accelerate cash flow by allowing immediate collection or extension of credit for patient payment based on a risk assessment

Registration Business Process Outsourcing Solution Benefits:

• Denied claims are substantially reduced (e.g., from 16% to 2%)
• Decreased “back-end” workload
• Compressed claims processing cycle
• Increased speed to claim and to revenue receipt
• Improved customer satisfaction
• Improved staff efficiency and increased skill development
• Decreased cost of admission and business office operations
• Improved third-party claims acceptance ratio
• Easy, low cost implementation
• Facilitates error identification and correction before the bill drops
• Helps determine inherent problems in existing processes and systems
• Return on investment (ROI) in 12 months or less
• Can increase operating profit by more than 2%
• No major capital expenditures