With the height of the pandemic, hospitals saw volumes of patients served crash and the payer mix vastly change. Revenue predictability has largely changed in 2020 as out-patient surgeries declined and unemployment increased. Being able to predict monthly revenue remains important to hospitals and there may be avenues to take to assist patients’ well-being while also ensuring the viability of the hospital’s business operations.
To begin with, a hospital will want to understand the payer’s journey. Often the case may be that the patient who lost coverage was a dependent on a family plan of employer-based coverage.
Anything that can be done to help patients pay their bills are options hospitals should review. Hospitals can truly act in a counselor role to help patients pay their bills. Hospitals can help patients fill out varying applications and explain the options.
Is it Worth it to Pay a Patient’s COBRA Coverage?
Always doublecheck with legal counsel and compliance officers, but if your patient is suddenly uninsured, one thing you can do is take on the COBRA payments for some patients. This can be in the interest of both parties. If you had a patient who was scheduled for a procedure, and as you’re verifying eligibility, you find out they’re suddenly unemployed/uninsured, this option could be something to consider. To determine whether this is beneficial, the question becomes what the reimbursement for the procedure along with other ancillary services would have been and what it will cost to make the COBRA payments for that specific patient. This option can go into a hospital’s toolkit as a possibility to help self-pay patients gain access to coverage.
Does the Patient Qualify for Medicaid?
You’ll want to assess self-pay patients for their options. If it’s not financially beneficial to the hospital to pay for a patient’s COBRA coverage, you can then see if they qualify for Medicaid.
Partner with Vendors for Non-Recourse Loans.
Hospitals can think about partnering with vendors to offer non-recourse loans to patients. Mentioning loans may carry a negative vibe to some, but these types of loans can be deferred until a patient regains employment.
If you don’t have visibility into self-pay after insurance, figure out how your hospital will track that. Collections for self-pay patients use a different method than from insurers. This can affect revenue predictability.
Ultimately, hospitals can work with a patient to help figure out how they can still have their procedure and/or surgery if they’re newly uninsured. There may be more than one way to subsidize the costs that can benefit both patient and hospital.
There are two footnotes healthcare professionals should watch for as legislation continues to change during the pandemic:
- There have been instances of government proposals that would have the government pay COBRA for some time. If this happened, hospitals wouldn’t have to make this decision.
- Watch for proposals that would ease requirements to qualify for Medicaid. This would ease poverty-level guidelines for families to qualify for Medicaid. Both would be favorable for patients and hospitals.
With over 30 years of experience, our Healthcare Advisory team understands the clinical, regulatory, reimbursement, and operational challenges facing today’s healthcare industry. Windham Brannon’s team can help you assess, optimize, and transform your hospital’s revenue cycle. Learn more and email Healthcare Advisory Practice Leader Valerie Barckhoff for further assistance.