Optimizing Financial Clearance to Thrive Amid COVID-19

Wanda BrooksJune 9, 2020

Healthcare billing statement with glasses and stethoscope.

As both providers and patients cope with the impact of COVID-19’s high cost, little relief is in sight.


For the U.S. healthcare system, COVID-19 testing and treatment costs will potentially range from $56 billion to $556 billion over the next two years. Hospitals stand to lose about $1,200 per COVID-19 case, or up to $8,000 depending on the payer mix – and that’s with the 20% increase in Medicare reimbursement.


For consumers, the financial impact is just as dire, perhaps doubly so: Besides potential job losses, reduced wages or lost revenue from businesses, they also have steeply climbing healthcare costs due to rising out-of-pocket responsibility or loss of insurance. Before the pandemic, nearly 30 million people – 9% of Americans – lacked health insurance coverage. Now, in a worst case scenario, uninsured numbers could increase to 40 million and the number of people with employer-sponsored coverage could decline by 12 million.


Financial clearance, which encompasses processes such as patient identity verification and eligibility checking, can help both providers and patients alike overcome these challenges. It can increase revenue from both patients and payers – ensuring data accuracy to prevent denials, determining which patients are likely to pay and connecting patients who need financial assistance with the right programs. The optimal financial clearance program always meets three criteria: It gives providers the most accurate financial information for every care encounter; finds the right financial pathway for each patient and ensures providers receive complete payment for all services. 


A key component of a financial clearance program is financial advocacy, which helps patients obtain funding if they can’t afford to pay for their healthcare.


R1’s best practice processes for financial advocacy helps ensure patients obtain the maximum amount of funding for which they qualify, as quickly as possible with minimal effort. For our provider clients, financial advocacy helps maximize reimbursement revenue from funding sources such as the Centers for Medicare and Medicaid Services (CMS), commercial payers, worker’s compensation and auto insurance – ultimately accelerating and increasing cash flow.


A closer look at financial advocacy best practices


1. Screen every patient to determine early on who is a potential financial advocacy case.

Whether they’re an inpatient or come in through the ED, our team of financial counselors identifies self-pay or uninsured patients and screens them as soon as possible – always working with clinicians to determine when it’s appropriate to begin the process. If the patient is identified as self-pay, they are referred to the care coverage team. Our care coverage team then works individually with each patient, asking a series of questions and using 501R and presumptive charity guidelines to determine eligibility for all possible funding sources. Patients should never leave without being asked if they need help paying their bill.


2. Use automation to help identify funding sources.

The care coverage team inputs data gathered from patient responses into an automated program that identifies all potential funding sources. After identifying these sources, the program goes a step further to populate each application with the information our team has entered. By removing manual research from the equation, we’re able to both identify and submit applications much more efficiently – which means the patient and hospital will receive funding more quickly, too.


3. Educate patients and support them through the application process.

The amount of paperwork and complexities associated with the application process can be extremely overwhelming for patients. We educate them about what to expect, what the next steps will be, any documentation we need from them and when we need it. This not only gives patients peace of mind – it also prevents missed deadlines or rejected applications. A constant attitude of empathy and helpfulness is important, too, which means you should develop a team of counselors who are passionate about what they do.


4. Stay closely aligned with agencies and payers.

Ideally, your financial advocacy team should be in constant communication with staff at Department of Health and Human Services, Centers for Medicare and Medicaid Services, the Social Security Administration, commercial payers, charities and any other organizations that offer funding. Beyond facilitating application submissions on patients’ behalf, you should also develop relationships with case workers and stay aligned on patient submissions. You’ll be able to better facilitate applications – and ensure your patients don’t miss out on funding due to missing information or late submissions of documentation.


5. Provide support for other funding sources as needed.

Many uninsured patients may also need financial help in other areas besides healthcare. Do they need assistance purchasing their food? Paying their utility bills? Our care coverage team helps identify potential funding such as the Supplemental Nutrition Assistance Program (SNAP), the Social Security disability program and the Supplemental Security Income program. Our financial advocacy team then facilitates the process for these applications. By helping patients obtain this type of funding, you can support their overall wellness by ensuring their basic needs such as housing and food are met.


Setting and reviewing performance metrics

Financial advocacy includes a great deal of human interaction from staff, patients and case workers, which make it rife with opportunities for errors and bottlenecks. Monitoring performance metrics is critical to ensuring your team is meeting its goals so patients can receive funding and your organization can be reimbursed in a timely manner. It’s important to review metrics in real time and share them with larger staff so you can make adjustments and implement ongoing improvements.


The following are two metrics that are especially tied to financial advocacy success:


  • Approvals and denials – Your team should be monitoring these metrics to see how many Medicaid and Medicare approvals are received. When you receive a denial, was it due to non-compliance – and if so, what happened? Track the length of time to receive approvals and if there are any lags, try to determine why. When the COVID-19 pandemic hit, for instance, approvals took longer – but we investigated and realized this was due to CMS staff transitioning to working at home.
  • A/R days – Watch each of your facilities’ A/R days, with an eye toward how long each funding source usually takes. Medicaid approvals generally take 45 days, so if A/R days are longer, investigate whether each team member is working his or her accounts appropriately.


For the potentially 40 million uninsured, financial advocacy offers one-on-one attention to help patients secure funding for healthcare or other critical necessities. It can help engage patients in their care, give them a better healthcare experience and increase their satisfaction with your organization. And as millions of Americans’ financial futures are uncertain, it can lay the foundation for patients to continue receiving benefits in years to come – fostering peace of mind and a better quality of life.


If optimized correctly, financial advocacy – as well as your overall financial clearance program – can be a strategic advantage that drives increased revenue, market share and patient loyalty. During a difficult time that isn’t over yet, these many benefits can make a substantial difference – and pave the way for a more successful future.


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Register or watch our webinar series, Maximizing Revenue and Improving the Patient Experience,  to learn how health system leaders can employ best practices for this “new normal” to engage patients and referring providers, reassuring them of the safety and necessity of seeking healthcare.


Author Bio: Wanda Brooks is a Senior Manager, Care Coverage, Operations at R1.

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