New payment experts to arrive at Cook hospitals on Monday
It's what every expert who has ever looked at the Cook County hospital system has advised: Get some people in to do nothing but help patients pre-qualify for private insurance coverage or Medicaid coverage in an effort to stem the red ink.
Monday, what has been an annually ignored mantra becomes a reality. Twenty new payment experts arrive for work at the Cook County Health and Hospitals System and will begin working with patients to make sure the system is collecting every dime it can from private insurers or Medicaid before it writes off those patients' bills as bad debt.
The workers are not county employees but employees of county contractor, MedAssets, which is helping the new, independent hospitals board in its entire overhaul of the system.
MedAssets already has about a dozen employees at Cook County who try to collect insurance payments or Medicaid for patients after they have been treated, or make so-called "back-end" collections. Their efforts, and the efforts of a new board that came on in June, have already increased collections at the hospital by $12 million over the earlier part of the year, according to a report detailed Thursday at the hospital's finance committee meeting.
The employees arriving Monday will be dealing with patients before they receive treatment, working as so-called "front-end" payment experts, said hospitals Interim CEO David Small. The idea is for patients who are scheduling a nonemergency procedure to deal with one of the counselors weeks or even months ahead of time. The counselors take insurance information, if the patient has any, and makes sure that any pre-authorizations necessary are taken care of so the county isn't denied payment by the insurance company down the road.
If patients have no insurance, the counselors will work with them to see if they qualify for Medicaid and get them enrolled.
This is "making sure there's nothing that's going to get in the way of our successfully collecting on that" procedure, said Small.
While starting this process was a relatively easy decision for the board, how much further they should go in beefing up collections became a point of contention Thursday when MedAssets presented a report advising the board to adopt new charity care policies. The policy advises following the lead of other public hospitals around the country and setting one cutoff level for charity care based at covering 100 percent of costs for any patient who makes 250 percent of the poverty level or less.
Currently, Cook hospitals have 9 levels ranging from 100 percent to 400 percent of the poverty line and covering anywhere from 5 percent to 100 percent of patient costs.
MedAssets representatives said, in reality, those not qualifying for charity care who didn't pay would still eventually be written off, but this way of doing it encourages people using the system to seek out other forms of coverage like government insurance programs or Medicaid.
But board members noted that receiving a multi-thousand-dollar invoice from the hospital might discourage them from coming back and thus defeat or hinder the hospital's mission of providing health care to poor people.
"I'm not sure I agree with a lot of what this policy says," said board member Heather O'Donnell.
Another step MedAssets recommends is restricting charity care to Cook County residents. That step has long been recommended by various parties because the hospital is funded, in large part, by Cook County residents, yet is utilized by other residents of other counties who do not pay into the system.
However, both former President John H. Stroger, and his son, Todd Stroger, have ruled the option out for fear of denying people needed medical care.
The board took no action on the recommendations Thursday.