Patient Screening and Eligibility Services

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IHMS has developed a unique series of programs that assist in delivering its services as an extension of your in-house financial counseling staff. IHMS combines its efforts with yours to provide patients, their families, and the community, an active resource regarding currently available sources to assist patients pay for medical bills.

In-House / Bedside Program

One of IHMS' most effective and most popular programs.
IHMS places on-site Eligibility Analysts (EA's) at the hospital to screen each self-pay admission for potential third party coverage. A financial review form is completed by the EA at the time of the patient interview. If the individual meets eligibility criteria for Government based medical assistance program (Medicaid / AHCCCS / Medi-Cal), an application is initiated. If there is an on-site eligibility worker from the State Agency, they are immediately contacted by IHMS to determine the status of the application. IHMS will assist in resolving any potential problems and may be required to take the patient to a face-to-face interview. The EA works closely with the patient and/or family member to obtain the necessary supporting documentation. The IHMS EA continues to work with the patient to insure the timely submission supporting documentation even after discharge. If other third party coverage is identified, the hospital system is updated accordingly, and the business office notified to bill the appropriate third party carrier.

The IHMS screening process includes a comprehensive review of the patient's financial status, followed by questions about the illness or injury. The process is designed to identify a potential third party payer by screening for the following:

• Employer based - Commercial Insurance
• Casualty Coverage (auto, homeowners, liability)
• Workers Compensation
• Medicaid / AHCCCS / Medi-Cal
• Out-of-State Medicaid
• State or County Based Funding
• Crime Victims Funds
• Charity

Each of our programs can be customized to meet the individual needs of our clients. Each provider has a unique set of goals and IHMS works closely with the provider to develop a program that achieves the desired results. It is this process of working together that sets IHMS apart. IHMS' clients are its business partners, and we endeavor to work together in the spirit of cooperation and understanding, with compassion and respect.

Discharge Program

This program targets all discharged self-pay classified accounts for review by an IHMS Eligibility Analyst for potential third party coverage. The program includes phone contact, letters, and field visits when appropriate. Each case is screened for potential third party coverage. If the individual qualifies for government based medical assistance, an application is initiated and filed with the appropriate government agency. This program includes the screening of all self-pay classified outpatient accounts with over $1,000.00 in accumulated charges, and ALL inpatient services. A successful discharge program usually includes the electronic processing of referrals.

Medicaid Pending Program

This program is designed to follow-up on all Medicaid Pending accounts. Most federally based eligibility programs are subject to a 45 day time limit to determine eligibility. If an application is pending for longer than 45 days it is frequently because patient information is missing, or incomplete. In these instances, It then becomes IHMS' responsibility to work with the patient and/or family members to obtain any missing or incomplete information so that an appropriate eligibility determination can be made.

Key Considerations for our Clients

IHMS offers its clients a number of advantages compared to other Patient Screening and Eligibility service providers:

• Increase in cash-flow
• Reduction of private-pay write-offs
• Maintain a positive public image
• Control capital expenditures
• Save on staffing and training costs
• Leverage advanced technology
• Achieve accounts receivable goals
• Improve customer and patient service

IHMS offers these advantages to you:

• More than 30 years of Eligibility (Medi-Cal, Medicaid and AHCCCS) experience
• Highly tenured Eligibility Analysts and management
• Ability to provide on-line access where ever the internet is present
• Ability to meet all reporting requirements
• Outbound Automated Notification System
• Proprietary (web-based) State-of-the-art computer and patient Eligibility software system (RAMS™ )
• Financial strength, stability and dynamic resources
• Full-service support
• Full range of related services, including Government Billing and Follow-Up and Out-of-State Medi-Cal services
• Procedures and policies in place to achieve regulatory compliance with HIPAA
• Competitive rates

In summary, IHMS possesses the abilities to be a quality partner. We possess the technology, experience, and employ the most skilled, professional people. Most importantly, we possess the commitment necessary to make your engagement work.

If you have any questions, please fill out our Contact Us Form.