Revenue Cycle
and Billing

Reducing Uncompensated Care with Non-clinical Case Management

by | Jan 27, 2022 | Healthcare, Insurance Discovery, Revenue Cycle Management

A recurring theme I heard during the HFMA Western Region Symposium last week was the correlation between patient experience and revenue. Good patient experience increases loyalty and your bottom line. 

For hospitals and health systems, this can seem like a daunting task because of the multiple touch points and the complexities of care delivery. Where do you start?

One of the most impactful strategies you can implement quickly and economically is what I refer to as non-clinical case management.

What is Non-clinical Case Management?

Non-clinical case management is an integrated approach to reduce uncompensated care and drive revenue to your hospital or health system by providing concierge-like enrollment and education services that improve access to in-network care and increase patient loyalty.

Assessment and enrollment services

A critical first step in the process is to assess each patient’s financial resources and eligibility prior to providing services. Using a healthcare broker to assess and enroll uninsured and under-insured patients for appropriate insurance coverage reduces the risk of patients falling through the cracks during handoff from your intake staff to an enrollment vendor. 

An experienced broker can enroll eligible patients in the appropriate insurance, including Medicare, Medicaid, and on and off exchange plans. They are also able to Increase access to subsidy programs designed to support special needs patients.

Patients benefit from getting access to comprehensive healthcare coverage that addresses all of their care needs, leading to increased loyalty. Your uncompensated care costs decrease and staff is freed up to provide direct patient care and assistance. 

Patient engagement and call center support.

Experienced broker staff work to educate patients on how to navigate the healthcare system and use in-network services to ensure minimal out-of-pocket expense, which drives revenue to you. 

Call center staff is responsible for verifying coverage eligibility and compliance, ensuring continuity of care for patients and reimbursement for services delivered by you. Call center staff is also available to answer patient insurance questions throughout the year.      

Financial analytics and reporting.

The data the non-clinical case management vendor collects allows them to build a best-practice, integrated provider and patient financial case management system, allowing you to identify, in real-time, HL7 EMR/EHR feeds on patient procedures. You can use data insight on patient populations and chronic care usage to determine financial programs offerings.

Why You Should Act Now

Your revenue has taken a beating due to COVID, from decreased patient volumes to the rise in the number of uninsured or under-insured patients you treat. Uncompensated care costs are rising, as are your labor costs. 

Your patient population has access to low cost health plans through the Affordable Care Act (ACA), with some premiums as low as $0 this year. And with the new low-income special enrollment period, patient households earning 150% or less of the Federal poverty Level (FLP), can enroll any time during this year. They can also switch plans once a month during 2022. 

Now is the time to take this critical step to increase your revenue and patient experience through non-clinical case management. American Exchange can help. We generated $1.2 million in additional care for one client, with as few as 88 patients.   

I’d be happy to provide further detail about how American Exchange is reducing uncompensated care costs for our clients.

Reach out to me on LinkedIn or call 1.888.995.1674.

I look forward to hearing from you.