Advanced Patient Advocacy (APA) recently conducted a study with 40 hospitals across the country. Our goal was to identify previously uninsured patients whom APA enrolled in medical coverage during a prior period in order to determine financial impact as it related to future visits to those same organizations.
Synthesizing patient utilization data for a defined twelve month period of time, APA was able to clearly attribute sustained future revenue funding to direct enrollment efforts without additional cost to the client. The increased revenue was accounted for in the following areas:
- Return Visits
- Future Medicare Patients
- Long Term Care assistance
- Full Medicaid for Exhausted Medicare Days
- DSH Days
Results from the study showed that each patient had a minimum of one return visit within 12 months. All of these patients had coverage that would reimburse the hospital for a portion of expenses. No additional funds were expended by the hospitals to Advance Patient Advocacy (APA) and the facility received an additional $35M in payments with no additional cost.
Future Medicare Patients
Our dedicated team of attorneys, paralegals and disability specialists represent every claimant through all levels of appeal—helping navigate the complex process to ensure the fastest approval. We pursue both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), providing further options for patients that may not be Medicaid eligible. We never outsource appeals to attorneys who charge your patients additional fees and slow down the approval process.
Because many disabled patients are frequent utilizers of health system resources, getting them approved for SSDI will ensure they can access Medicare coverage to pay for their long-term healthcare needs and provide them a source of income. By assisting patients in obtaining SSDI they become eligible Medicare within two years. Reviewing long hospitalizations and working with patients who may have recently acquired a disabling condition is a proactive approach to preventing a gap in coverage and ensuring long term benefit.
Long Term Care Assistance
When it is determined that a patient may no longer need in-hospital services and might be more clinically appropriate for a rehabilitative or long term care environment, APA works closely with your Case Management Team to help facilitate that process. We secure necessary documentation and expedite the application process resulting in a reduction in non-covered days for the patient and avoidable cost to your organization.
Full Medicaid for Exhausted Medicare days
Medicare beneficiaries may also qualify for Medicaid benefits because of limited income; often referred to as dual eligibility. Should a Medicare patient exhaust his/her covered days benefit during a hospitalization, APA will screen them for Medicaid eligibility. If eligible, Medicaid will pay all associated co-insurance and life time reserve days. This reduces the hospital’s risk for uncompensated days and provides the patient with secondary coverage on future visits.
Under the Social Security Act, hospitals that serve a disproportionately high percentage of low income patients are entitled to receive DSH payments. There are two components to the DSH qualification: the Medicaid fraction and the Medicare fraction. Screening all patients for both SSI and Medicaid programs, who have been hospitalized for above average lengths of stay (even those with commercial insurance) will ensure that you reduce any potential gaps in coverage and maximize your DSH qualifying days. Additionally, patients who lose their job due to their injury or illness may be eligible for SSDI and future Medicare coverage.