Eligibility Programs
Each of our Eligibility Programs is designed to reduce bad debt by converting self-pay classified accounts to a verifiable third party payer. 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:
- 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
The process of screening patients for third party coverage is designed to augment the activities of existing hospital staff and to increase the level of service to the patient and their families. The work performed by IHMS is part of the hospital's overall delivery of community based services. Our goal is to convert your self-pay classified accounts into third party dollars thereby effectively reducing your overall bad debt; maximizing third party reimbursement; and providing your patients with the assistance they need, when they need it.
What makes IHMS different among eligibility vendors is that IHMS returns to the hospital any case with verified third party coverage other than a government based payer, free of charge. This includes Medicare accounts whereby the patient simply failed to alert admissions about Medicare coverage. As a "value" added service IHMS can update the hospital system with all third party information.
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. Our clients are our business partners and we endeavor to work together in the spirit of cooperation and understanding, with compassion and respect.
In-house / Bedside Program
This is one of our most effective and popular programs. IHMS places on-site Patient Financial Analysts (PFA's) at the hospital to screen each self-pay admission for potential third party coverage. A financial review form is completed by the PFA 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 PFA works closely with the patient and/or family member to obtain the necessary supporting documentation. The PFA 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, and the business office notified to bill the appropriate third party carrier.
Discharge Program
This program targets all discharged self-pay classified accounts for review by a PFA 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 $1000 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 usually because information is missing or incomplete. It then becomes the responsibility of IHMS to work with the patient and family to obtain the missing or incomplete information so that an appropriate eligibility determination can be made.
CICP Review Program
This program is unique to Colorado and targets accounts classified under the Colorado Indigent Care Program (CICP). While the CICP program provides coverage to many Colorado residents who would otherwise have none, the level of reimbursement is substantially lower than under the Colorado Medicaid Program. In response to this disparity, IHMS developed a program that has our PFA's reviewing accounts classified under the CICP Program for potential Medicaid eligibility. Many of these patients qualify for Medicaid and simply did not complete the process or were never directed to apply. Our PFA's work closely with your patients to determine whether or not Medicaid is a possibility and then assists them throughout the application process. As with all Eligibility programs, IHMS is there to help. Every effort is made to remove obstacles including paying for babysitters and birth certificates, and providing transportation to and from the local medical services office.
Key Benefits to our Clients
- Reduced Bad Debt
- Increased Third Party Collections
- Multipurpose Financial Screenings
- Discharge Planning Assistance
- Field Visits to Locate Patients, Obtain Signatures, and Retrieve Paperwork
- Quality Assurance - Updated Registration Information
Key Benefits to your Patients
- Transportation to and from the Local Eligibility office
- Application Assistance
- Payment for Baby Sitters
- Application Assistance at Home
- Payment for Birth Certificates
- Bilingual Application Assistance
- Food Stamp Application Assistance
- Referral to other Community Based Services
- Assistance in Completing SSI paperwork
- Assistance during SSI Hearings
Capabilities
Electronic Referral Processing
IHMS can begin processing referrals under any of these programs almost immediately. Only a face sheet is required to make a referral. However, we highly recommend an electronic referral format. IHMS can process referrals daily, weekly, or monthly depending on the program.
Referral Volume Management
IHMS can handle increases in volume without an interruption in service. For example, Monday's usually are busy days for admissions and while IHMS may have only 1 or 2 PFA's on-site other trained PFA's can be dispatched from the local office to assist with the added patient volume..
Field Visits
IHMS reviews each discharged case for potential field visits to complete and application or to retrieve supporting documentation. Field visits are scheduled and monitored by management.
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