Convert Uninsured Patients to Medicaid and/or Medicare Coverage
Most hospitals have staff and consultants who screen indigent patients for Medicaid eligibility, a process that appears fairly straight-forward. If the patient meets income/asset and disability threshold requirements the Medicaid application is filed, and once approved, the hospital may bill Medicaid for services.
However, many people, especially in non-expansion Medicaid states, are not eligible for this program unless they first qualify for SSI (Supplemental Security Income). For Social Security to award this benefit, the patient must demonstrate limited income and resources as well as a finding of severe disability. In some circumstances, the associated Medicaid can be retro-active for up to three months prior to the month of application. What seemed straight forward may become complex given the many variables.
Alternatives Exist – SSDI
HRS specialists know disabled patients with a significant work history, but who exceed the poverty guidelines for SSI, may qualify for Social Security Disability Insurance (SSDI) also known as “Federal Old-Age, Survivors and Disability Insurance Benefits”. This federal program has
• the same complex disability requirements as SSI, but has no income or assets thresholds.
• Rather than assets, past work history and payroll taxes are evaluated.
• Benefits start five months after the date the patient could no longer work (which can be retro-active) and
• Medicare starts 24 months after the first SSDI benefit check.
In some states a number of SSDI beneficiaries also qualify for Medicaid.
The Keys to a Successful Disability Advocacy Program
1. Early and comprehensive identification of uninsured, disabled patients who demonstrate a “severe” medical condition which Social Security will determine to preclude “substantial gainful employment”. Additionally, the condition must be expected to last at least 12 months or result in death.
2. Accurate and complete case management of the disability claim through all necessary stages of the adjudication. HRS intervention entails:
a) Provision of short training sessions for hospital case management staff to facilitate their referral of appropriate cases.
b) Use HRS Clinical Data Analytics to screen a daily feed of all self-pay patients. Using certain clinical data, the software will identify patients with potential disability.
c) Onsite Disability Case Managers personally screen those computer selected individuals and initiate the disability process.
d) Offsite Disability Managers follow up with appropriate patients who have already been discharged.
e) Patients actively being worked for Medicaid by Eligibility Services will be screened out
f) HRS staff assists viable candidates with accurate completion of all forms and interviews with SSA.
g) Our staff submits all necessary medical evidence to Social Security
h) As Appointed Representative our staff advocates on patient’s behalf in all subsequent writings, appeals and hearings
i) We track all cases and report monthly to the facility to provide data for prompt billing of Medicaid and Medicare.
Professionals provide valuable interface throughout these many steps working toward a positive outcome that otherwise may not occur.
Transform Bad Debt to Medicaid & Medicare Payments, Increase DSH and Reduce Readmissions.
Hospitals benefit from Disability Advocacy enrollment in several ways:
• where the hospital once collected pennies on the dollar for Bad Debt, they may now bill Medicaid and eventually Medicare for services
• incremental “Eligible Days” enhance DSH math, increasing DSH payments or possibly meeting the DSH and/or 340B thresholds
• reducing re-admissions, lowering ACA penalties
• increased physician reimbursement
• complimenting existing community service initiatives
Patients Afforded Meaningful Health Coverage and Income
The low-income uninsured can be heavy users of hospital services. Unable to afford preventative care and medications, these patients tend not to fill prescriptions they can’t afford, may fail to follow medical regimes, and ultimately find themselves back in the ER…over and over again.
But once enrolled in SSI/SSDI and provided coverage, these patients begin to find their footing, and become healthier relying on the primary care physician and not the
hospital ER as a last resort. While the process can exceed over 600 days if the case requires a hearing, most successful SSI disability applicants begin receiving their retro-active payments within 4 to 6 months at the full Federal Benefit Rate (currently
$750. A month)
Candidates Are Not Charged for Services and Client Fees Are Contingent Upon Net Gain by the Provider.
Lawyers typically charge up to $6,000 for preparing disability applications, consulting and representation at hearings/challenges to the application. HRS charges the candidate no fee of any kind, with no upfront cost to provider. Hospital Fees for HRS Disability Advocacy services are based upon increased Medicare/Medicaid payments plus increased DSH or LIP. All this with little or no disruption to on-going hospital operations.
Ask Us for Your Network/Hospital SSI/SSDI Revenue Projections.
We are readily available to meet with your management team to discuss the program in more detail. Our Disability Advocacy enrollment experience provides performance metrics enabling us to forecast revenue for your organization. Financial templates, with an experiential foundation, reflect incremental Medicaid and Medicare revenue by Year 3, based on 2017 Cost Reports for ACA Medicaid Non-Expansion States. Projections can include ratio of incremental Disability Revenue to DRG.
Orientation toward Action
Given recent experiences, our process is well defined
• 1 week with Technology specialists
• HRS Case Workers in Place
• Coordinate with Screeners
• HRS CRM tracks pipeline
• 3 to 6 months begin billing CMS
For more information, contact us: email@example.com