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Case Study
Streamline Medicaid Eligibility and Enrollment for Increased Patient Satisfaction
“We wanted to use one expert vendor that could do all this more efficiently, so we could focus our internal staff’s time on their important and high-touch functions.”
- Denise Szalko
Vice President of Revenue Cycle
Rush University Medical Center
Customer
Rush University Medical Center
Chicago, Illinois
Challenge
Streamline Medicaid eligibility and enrollment
Products
Eligibility & Enrollment Services
-Self-Pay Coverage Services
Results
- More than 25,000 accounts accepted by Medicaid in last 10 years, representing more than 15,000 patients
- More than $934 million in gross charges approved for coverage in last 10 years
- 96% approval rate
The Customer:
Named a top U.S. hospital by U.S. News & World Report, Rush University Medical Center is one of Chicago’s finest healthcare providers. It’s part of the Rush system, which includes Rush University, Rush Copley Medical Center, and Rush Oak Park Hospital, as well as numerous outpatient care facilities.
With a history spanning more than 175 years, Rush University Medical Center has been part of the Chicago landscape longer than any other healthcare institution in the city. Since 1837, it has worked alongside self-pay, underinsured, and underprivileged patients to help them identify and enroll in additional benefit resources. Rush University Medical Center has 664 beds, employs 10,000+ staff, and admits more than 35,000 patients annually.
The Challenge: Limited Staff Expertise Slows Down Eligibility and Enrollment Processes
The rise of healthcare consumerism has prompted many hospitals and health systems to rethink their patient satisfaction strategies. The beginning of the patient’s financial journey is an opportune time to find ways to reduce out-of-pocket costs for underinsured patients.
Identifying patients who qualify for Medicaid can help hospitals and health systems accomplish these key objectives:
- Lessen the number of uninsured patients who may have a difficult time paying for their care
- Decrease uncompensated care and the risk of bad debt
Rush University Medical Center had a strong tradition of helping Medicaid-eligible patients find additional coverage, but managing a growing uninsured patient population was proving difficult. Long accounts receivable (A/R) days and delayed payments from payers, including Medicare, were increasingly challenging.
At the same time, Rush University Medical Center struggled to keep up with advancing technologies and provide specialized training for its already overburdened staff. It was hard for employees to stay up to date on recurring compliance changes from the Office of Inspector General (OIG) and Centers for Medicaid & Medicare Services (CMS), in addition to completing their day-to-day responsibilities.
Along with payment and compliance issues, Rush University Medical Center wanted to increase its presence in the community to attract and retain patients and improve patient satisfaction during their visits. To achieve these goals, the healthcare organization knew it needed to improve transparency around healthcare and third-party benefits and provide additional tools to make it easier for patients to schedule appointments, access e-statements, and make payments—all of which were difficult to do with limited internal resources.
The Solution: Eligibility and Enrollment Services Help Simplify and Speed Up Medicaid Enrollment
Over the years, Rush University Medical Center alternated between performing Medicaid eligibility and enrollment processes in-house and outsourcing the functions to a vendor—but neither solution produced significant results on an ongoing basis.
As a result, Rush University Medical Center decided to try something new and outsource its eligibility and enrollment functions to Change Healthcare because of its community-wide reputation for providing those niche services.
“Being able to rely on a firm that has the resources to keep its staff up-to-date on industry trends and evolving regulations better than we could accomplish internally as a small program is invaluable to us,” said Denise Szalko, vice president of Revenue Cycle at Rush University Medical Center.
Szalko appreciates how Change Healthcare staff members work shoulder-to-shoulder with her staff at every level—from revenue cycle leaders sourcing solutions to onsite facility staff carrying out the strategies.
“It’s all about the people,” Szalko said. “Healthcare is such a relationship business. Their on-site staff is very easy to work with. They’re very trustworthy and have a high level of integrity.”
With the expert staff from Change Healthcare focused solely on assisting patients to enroll in Medicaid, Rush University Medical Center’s internal staff had more time to do what the organization does best—take care of patients.
The Result: Simplified Patient Eligibility and Enrollment
Throughout its 10-year relationship with Change Healthcare, Rush University Medical Center has helped more patients qualify for Medicaid—which improves patient satisfaction and reimbursement levels. To date, more than 25,000 accounts have been accepted, representing more than 15,000 patients. More than $934 million in gross charges have been approved for coverage, at a 96% approval rate. By giving patients access to additional funding sources in the beginning of their journey, they find a clearer path to affordable care.
“We recognize there are more factors that go into a patient’s decision in terms of where they choose to get their healthcare,” Szalko said. “Improving our Medicaid eligibility and enrollment doesn’t just benefit Rush University Medical Center, but it is a valuable service for our patients, too. We do because we do everything we can to ensure they can get the very best healthcare for them, even if it’s not at Rush University Medical Center.”
The Medicaid eligibility and enrollment services provided by Change Healthcare help Rush University Medical Center achieve its goals of reducing bad debt and uncompensated care, increasing patient satisfaction and loyalty, and strengthening its brand.
Eligibility & Enrollment Services
Change Healthcare helps hospitals and health systems optimize revenue by guiding patients through the complexities of paying for medical care with our Eligibility & Enrollment Services. This solution suite is ideal for Emergency Departments as well as inpatient and outpatient services.
Hospitals can choose one or more of the services provided to:
- Proactively identify and enroll self-pay patients in appropriate government-funding sources
- Educate patients on their financial responsibility and devise payment plans before their scheduled visits or at the point of service
- Help optimize reimbursement for complex, accident-related claims, including motor vehicle accident (MVA) and workers’ compensation
- Uphold patient satisfaction as well as compliance with state and federal regulations, while helping collect more from patients