Missouri Medicaid Expansion

Missouri Medicaid Expansion: More Low-Income Patients Now Qualify for Coverage

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EligibilityAdvocates Blog

Missouri Medicaid Expansion: More Low-Income Patients Now Qualify for Coverage

Posted on Wednesday, September 1, 2021

The Missouri Supreme Court ruled an order in July of 2021 instructing the state to proceed with Medicaid expansion. This will improve healthcare access in Missouri as up to 275,000 low-income residents are expected to gain eligibility.

Missouri Medicaid Expansion

Missouri Medicaid expansion will help more low-income patients at your Missouri hospital gain health coverage.

 

What Does Missouri Medicaid Expansion Mean for Your Missouri Hospital?

More of your low-income patients will now qualify for health coverage through Missouri Medicaid. Having staff available to screen your patients for eligibility while in house will increase the number of patients who apply and are ultimately approved.

Those who are newly eligible under Missouri Medicaid expansion may now submit their applications, although the state expects to start processing them after October 1, 2021.

While these applications may not be processed until October, it is in your patients’ (and your hospital’s) best interest that eligible patients begin enrolling now. According to the Governor’s Office, “Qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date.”

Helping Your Patients Gain Health Coverage Under Missouri Medicaid Expansion

EligibilityAdvocates’ Patient Advocates can screen your patients on site and assist them with the Medicaid application process. We also educate patients on their financial responsibilities and new health coverage. All of our services are free to patients as we are contracted at a performance-based rate with each healthcare facility.

Providing our service to your patients will help ensure that eligible patients are aware that they may qualify for Medicaid and that their applications are completed fully and correctly. Additionally, our Patient Advocates can aid patients in applying for other financial assistance programs that could help cover the cost of their medical expenses and thereby lower your uncompensated care.

Contact us today to learn more about how we can help your eligible patients gain health coverage under Missouri Medicaid expansion.

A patient is prepped to receive a COVID-19 vaccine and the blog title appears – COVID-19 Services for Uninsured Patients: FAQs

COVID-19 Services for Uninsured Patients: FAQs

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EligibilityAdvocates Blog

COVID-19 Services for Uninsured Patients: FAQs

Posted on Thursday, August 26, 2021

Currently, COVID-19 testing, treatment, and vaccines may be free to anyone without health insurance.1

Below are answers to frequently asked questions that many uninsured patients have.

FAQs: COVID-19 Services for Uninsured Patients


A patient is prepped to receive a COVID-19 vaccine and the blog title appears – COVID-19 Services for Uninsured Patients: FAQs

At this time, free COVID-19 services for uninsured patients include COVID-19 testing, treatment, and vaccines.

Which COVID-19 services are free to uninsured patients?

COVID-19 testing, treatment, and vaccines are all available as free services to uninsured patients.1

Why are these COVID-19 services free?

COVID-19 services for uninsured patients are paid for by the federal HRSA COVID-19 Uninsured Program.1

What if I receive a bill for COVID-19 services?

You should contact your provider/healthcare facility and request that they bill the HRSA COVID-19 Uninsured Program instead of you.1

What if I have already paid the bill I received for COVID-19 services?

You may be entitled to a refund if your provider billed HRSA as well. First, check if the bill lists HRSA reimbursement for the COVID-19 services. Also, contact the provider/healthcare facility who billed you to discuss a possible refund.2

If you cannot obtain a refund that you believe you are due, you may file a complaint with the HHS Office of Inspector General by calling the hotline at 1-800-HHS-TIPS or visiting their website (https://TIPS.HHS.GOV).2

You may be responsible for payment if the care was not eligible for HRSA reimbursement or the provider did not submit the claim to HRSA. However, at this time, any provider administering COVID-19 vaccines cannot charge you for the vaccine or administration of the vaccine.2

Does immigration status affect eligibility for free COVID-19 services?

No; all uninsured patients are eligible for free COVID-19 services regardless of immigration status.1

Will my immigration status be reported to an immigration agency if I receive free COVID-19 services?

According to HRSA, “Testing, treatment or vaccinations paid for by the federal government will not affect anyone’s immigration status or be shared with immigration agencies.”1

Do I need a Social Security Number or government ID to obtain free COVID-19 services?

No; although you may be asked for this information by the healthcare facility or pharmacy, you can still receive free COVID-19 testing, treatment, and/or vaccination if you unable to provide it.1

EligibilityAdvocates: Helping Uninsured Patients


EligibilityAdvocates assists uninsured patients with finding health coverage and/or applying for other programs to help cover their medical costs. Our services are free to patients.

To learn more about how we help patients, please read the stories of how our Patient Advocates are making a real difference in patients’ lives.

Contact us to reach an EligibilityAdvocates Representative or for more information on COVID-19 services for uninsured patients.


Sources

Answers to the questions above were obtained from:

1 HRSA (Health Resources & Services Administration). “Uninsured Patient COVID Services Poster.” (2021). Retrieved from https://www.hhs.gov/sites/default/files/uninsured-patient-covid-services-poster.pdf

2 HRSA (Health Resources & Services Administration). “Impact on Patients.” (2021). Retrieved from https://www.hrsa.gov/provider-relief/patient-impact/


By Stephanie Salmich

Native American children appear along with the words - Medicaid Expansion: Its Effect on IHS Facilities, American Indians, & Alaska Natives

What Does Medicaid Expansion Mean for Indian Health Service Facilities, American Indians, & Alaska Natives?

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EligibilityAdvocates Blog

What Does Medicaid Expansion Mean for Indian Health Service Facilities, American Indians, & Alaska Natives?

Posted on Thursday, July 8, 2021


Medicaid expansion can improve healthcare access for the American Indian and Alaska Native (AI/AN) community in many ways, including by providing health coverage to a larger portion of the population and by increasing third-party revenue for Indian Health Service (IHS) facilities.

Native American children appear along with the words - Medicaid Expansion: Its Effect on IHS Facilities, American Indians, & Alaska Natives

Medicaid expansion can improve healthcare access for AI/AN people and increase third-party revenue for IHS facilities.

Expanding Health Coverage for AI/AN People


As of 2019, an estimated 19.1% of American Indian and Alaska Native people in the U.S. were uninsured.1

Inadequate health coverage is a significant barrier to healthcare access and often causes patients to delay or avoid medical care altogether.

In states that expand Medicaid, more people qualify for Medicaid based on income; so, more members of the AI/AN community become eligible for Medicaid coverage and may no longer be uninsured. This helps remove a major obstacle to healthcare access and enables many AI/AN people to obtain care from other providers in addition to their IHS facility.

Increasing Third-Party Revenue for IHS Facilities


After states were given the option to expand their Medicaid programs beginning in 2014, third-party collections for federally operated IHS facilities increased by 51% from 2013 to 2018.2

During that same timeframe, the percentage of patients at these facilities who reported having health insurance increased by an average of 14 percent, with facilities located in states that expanded Medicaid seeing the biggest increases.2

An increase in third-party revenue in the form of payments from patients’ Medicaid and private health insurance coverage made it possible for IHS facilities to expand their on-site services and lower the need for patients to use the Purchased/Referred Care (PRC) program, while also allowing for an extension in the complexity of services delivered off-site through PRC.2

If your IHS facility is in a state that is or will be expanding Medicaid, you can also expect a boost in third-party revenue as a result. This money can be used toward adding more providers and specialty services, purchasing medical equipment, facility maintenance, and more, all of which will greatly enhance the quality and accessibility of care for your AI/AN community.

Best Practices for Optimizing Self-Pay Conversions & Third-Party Revenue


A patient eligibility and enrollment service can ensure that as many of your patients as possible gain coverage under Medicaid expansion by:

  • Helping patients apply for Medicaid – Eligibility professionals have the resources and expertise to help patients correctly and more efficiently complete their Medicaid applications.
  • Screening patients before discharge – Patients may not realize they qualify for Medicaid, and those who are screened for eligibility and engaged before they leave your facility will be much more likely to follow through with the Medicaid application process.
  • Meeting with patients one-on-one and in person – Face-to-face and personalized engagement with patients results in higher self-pay conversion rates than attempts to assist patients via email and phone alone.

EligibilityAdvocates: Helping IHS Facilities Maximize the Benefits of Medicaid Expansion


Our Patient Advocates work on site to help patients enroll in Medicaid and other health plans or financial assistance programs. By finding alternative funding sources for patients’ medical costs and helping them apply, we can increase your third-party revenue and improve patients’ access to care.

Our services are free to patients and provide a guaranteed ROI for our clients thanks to our performance-based pricing model. We are only paid once we’ve successfully helped you collect reimbursement.

EligibilityAdvocates delivers more self-pay conversions through one-on-one interaction with patients, a pre-discharge screening rate of 90 percent, expanded on-site hours and home visits, advanced technology and screening software, and our expertly trained, compassionate staff who are changing patients’ lives every day.

Contact us to learn more about how we can increase Medicaid enrollment at your IHS facility and help you maximize the benefits of Medicaid expansion.


Sources:

1 United States Census Bureau. “Selected Characteristics of Health Insurance Coverage in the United States.” (2019). Retrieved from https://data.census.gov/cedsci/table?q=Health%20Insurance&g=0100000US&y=2019&tid=ACSST1Y2019.S2701&hidePreview=true

2 GAO (United States Government Accountability Office). “GAO-19-612 Highlights, Indian Health Service: Facilities Reported Expanding Services Following Increases in Health Insurance Coverage and Collections.” (2019). Retrieved from https://www.gao.gov/assets/gao-19-612-highlights.pdf


By Stephanie Salmich

A community of hands forms a heart shape around the words “Eligibility REDEFINED.”

Eligibility REDEFINED: EligibilityAdvocates Sets the New Standard in Patient Eligibility

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EligibilityAdvocates Blog

Eligibility REDEFINED:

EligibilityAdvocates Sets the New Standard in Patient Eligibility

Posted on Tuesday, June 1, 2021

At EligibilityAdvocates, we are redefining patient eligibility and enrollment. Our Patient Advocates are raising the bar with higher performance standards, increased patient engagement, and (above all) a heartfelt commitment to patients, hospitals, and their communities.

Read on to learn how we go above and beyond to help our clients and their patients!


Eligibility REDEFINED: The EligibilityAdvocates Difference


A community of hands forms a heart shape around the words “Eligibility REDEFINED.”

EligibilityAdvocates is Eligibility REDEFINED.

On-Site Patient Advocates – Many other patient eligibility companies assist patients via email and phone or transitioned to conducting business remotely this past year. But even during the height of the pandemic, our Patient Advocates met in person (including home visits) with patients to help them obtain health coverage and/or financial assistance and other benefits.

We implemented extensive safety precautions to make this possible to ensure our clients’ patients were able to access the eligibility services they needed – and at a time when many were especially in need of this help. Our face-to-face interactions with patients build trust and result in higher conversion rates.

Expanded Coverage Hours – Patients need help outside of the typical Monday through Friday, “9 to 5” workday, yet most other patient eligibility and enrollment services operate within that timeframe. Our Patient Advocates are available on site, including in the Emergency Department, to help patients at a minimum of 12 hours/day, 6 days/week – and up to 24 hours/day, 7 days/week (based on peak analysis).

Screening Rate of 90 Percent – EligibilityAdvocates screens 90% of our clients’ uninsured patients BEFORE discharge. Patients who are screened and engaged before they leave the hospital are much more likely to follow through with the benefit application process.

We further increase patient engagement through bedside screening, home visits, and in-field patient advocacy. We then follow up with patients through their preferred communication method (e.g., text, email, letter) to keep them engaged as well.

Community Impact & Outreach – Our motto is, “Impacting Communities, One Patient at a Time.” Our Patient Advocates are passionate about making a difference in the lives of patients and their communities. This means they go the extra mile to assist patients beyond their medical bills, in any way they can.

For example, our Patient Advocates have:

Additionally, we volunteer our services at community health fairs where we enroll residents in Medicaid or Marketplace insurance plans.

We also create job opportunities; our Patient Advocates are hired locally, expertly trained, and genuinely invested in the well-being of their own community.

Travel Assistance – When patients have no other mode of transportation, we can arrange for travel assistance so that they can meet in person with one of our Patient Advocates or attend a hearing at the Medicaid or Disability Office. This is provided at no cost to the patients or our clients.

All Accounts Worked – Many patient eligibility organizations focus only on the easier or high-balance cases. At EligibilityAdvocates, we work EVERY account across all areas (e.g., inpatient, outpatient, ED) and unlinked accounts are closed within 30 days. We make this commitment to pursuing the tough claims for our clients because we care about each patient and understand the impact this effort will make on your relationship with them.

Out-of-State Medicaid Services – One type of complicated claim which is frequently written off is the out-of-state Medicaid account. We can handle all aspects of out-of-state Medicaid enrollment, billing, and follow-up so that our clients don’t miss out on this substantial form of reimbursement. Our out-of-state Medicaid team has experience in all 50 states’ Medicaid programs.

Technology – EligibilityAdvocates is powered by HealthWare Systems’ patient engagement and revenue cycle technology solutions. HealthWare Systems has been a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software since 1998.

Our proprietary software, AdvocatorAI, is a comprehensive patient screening tool that finds existing coverage in real time and identifies alternative funding sources for patients’ medical bills while supporting patient advocacy through financial counseling and assistance. AdvocatorAI streamlines the benefit application process by producing application forms electronically and auto-populating them with patient data.

We also provide transparency of account status at all times through customizable dashboards, reports, and alerts.

Performance-Based Pricing – Choosing EligibilityAdvocates as your on-site patient eligibility and enrollment service equates to a guaranteed ROI. We offer contingent fee pricing; we are only paid once we’ve successfully helped you collect reimbursement.

Most notably, the return on investment in regard to the impact our services can have on your patients and community is invaluable. At EligibilityAdvocates, we are truly changing lives.

EligibilityAdvocates: Eligibility REDEFINED


EligibilityAdvocates merges cutting-edge technology with the personal and human touch of our expert, on-site Patient Advocates to deliver higher performance standards, increased patient engagement, and a real, lasting impact on the community.

Contact us today to start maximizing patient advocacy at your facility while improving the financial outlook of your patients, organization, and entire community.


By Stephanie Salmich

The logo of patient eligibility service and out-of-state Medicaid billing company EligibilityAdvocates.

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

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Press Release

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

FOR IMMEDIATE RELEASE: May 4, 2021

Elgin, IL:  HealthWare Systems has partnered with a new company, EligibilityAdvocates, which offers patient eligibility and out-of-state Medicaid billing services. The new organization is powered by HealthWare Systems’ revenue cycle technology solutions.

EligibilityAdvocates’ on-site patient eligibility and enrollment service helps self-pay and uninsured patients find and obtain health coverage and/or financial assistance. On-site patient advocates and technology facilitate real-time coverage detection, eligible program screening, and timely account appropriation.

The logo of patient eligibility service and out-of-state Medicaid billing company EligibilityAdvocates.

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

EligibilityAdvocates provides expanded coverage hours and ED staffing and its patient advocates utilize tablets/laptops equipped with the company’s proprietary software AdvocatorAI, a comprehensive screening tool that identifies existing coverage or alternative funding sources for patients’ medical bills while supporting patient advocacy through financial counseling and assistance.

The new company also offers an off-site out-of-state Medicaid service that operates as a performance-based extension of its clients’ revenue cycle teams. EligibilityAdvocates is experienced in all 50 states’ Medicaid programs and handles all aspects of out-of-state Medicaid enrollment, billing, and follow-up so that hospitals don’t miss out on this substantial form of reimbursement.

EligibilityAdvocates reduces health organizations’ uncompensated care and account cycle time, increases self-pay conversions, and provides transparency of account status at all times through customizable dashboards, reports, and alerts.

“HealthWare Systems has always believed in creating patient-first technology and developing solutions that improve the financial outlook for all stakeholders in a health system – including patients, providers, healthcare facilities, and the entire community,” stated Steve Gruner, CEO and Founder of HealthWare Systems. “EligibilityAdvocates has created the perfect opportunity to leverage the power of our ActiveWARE products to drastically reduce patients’ out-of-pocket costs and hospitals’ uncompensated care.”

“I am proud of the EligibilityAdvocates team who have already proven their ability to rise above unprecedented challenges during the pandemic as well as their selfless dedication to patient support, especially during this time when patients and their families need it most,” said Gruner.

Jeff Woody, Chief Revenue Officer at EligibilityAdvocates, agrees and said he looks forward to sharing the inspiring stories of how EligibilityAdvocates’ patient advocates go above and beyond for those they serve:

“At EligibilityAdvocates, our motto is ‘Impacting Communities, One Patient at a Time.’ Our patient advocates are truly committed to making a difference in the life of each patient they assist, and they are able to maximize their patient advocacy with the help of HealthWare’s state-of-the-art technology that allows them to more accurately and efficiently serve patients and deliver results.”

To learn more about the patient eligibility service and out-of-state Medicaid billing company, visit www.eligibilityadvocates.com where you will find further details about EligibilityAdvocates’ services, patient resources, and an educational blog covering patient advocacy and out-of-state Medicaid issues.

About HealthWare Systems:


HealthWare Systems is a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software. We specialize in applying robotic process automation (RPA) to healthcare processes to improve both the patient experience and the revenue cycle. Our ActiveWARE suite of products manages pre-arrival, financial assistance, early out, collections, denial management, claims follow-up, and more, and is proven to maximize productivity and profitability so that healthcare teams have more time and resources to spend on quality care.

About EligibilityAdvocates:


EligibilityAdvocates’ patient eligibility and enrollment service utilizes technology proficiencies to enable our patient advocates to optimize one-on-one interaction with self-pay/uninsured patients to reduce uncompensated care. We provide real-time coverage verification, a comprehensive screening tool (AdvocatorAI), and expanded on-site coverage hours. We also offer an experienced off-site team to handle your out-of-state Medicaid enrollment, billing, and follow-up. Our complementary goals of promoting patient advocacy and improving your revenue cycle go hand-in-hand as we strive to create a healthier financial environment for your entire community.

Contact Information:


Name: Stephanie Salmich
Organization: HealthWare Systems
Address: 2205 Point Boulevard, Suite 160, Elgin, IL 60123
Phone: (847) 649-5100

A Patient Advocate assists a patient, and the blog title appears – The Keys to Increasing Patient Collections: Patient Communication & Financial Education

The Keys to Increasing Patient Collections: Patient Communication & Financial Education

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EligibilityAdvocates Blog

The Keys to Increasing Patient Collections:

Patient Communication & Financial Education

Posted on Monday, April 12, 2021

A successful strategy for increasing patient collections must be proactive.

Unfortunately, many patient collection efforts are hindered by reactive methods (e.g., lack of price transparency or out-of-pocket estimates, hard-to-decipher medical bills) that result in uncertainty, stress, and confusion for patients.

When patients are confused about what they owe and why they owe it, they often delay making payments or do not pay their bill at all. Additionally, those with high or unexpected medical bills are more likely to call the hospital’s billing office with questions or complaints. And if they feel they’ve had a poor experience with the billing department, they are less likely to pay their bill in full or in a timely manner.

A Proactive Plan for Increasing Patient Collections

A proactive approach involves two key elements: patient communication and financial education. EligibilityAdvocates employs both in the services we offer.

Patient Communication


EligibilityAdvocates’ on-site patient eligibility service increases self-pay conversions and improves patient collections through better patient engagement. Our Patient Advocates meet with patients one-on-one and in-person to assess and help them understand financial assistance opportunities and their options, all while they are still at your facility and before they are billed.

Equipped with mobile screening technology, our Patient Advocates are also able to meet with patients at home, in the field, or at bedside. We also offer Emergency Department staffing and expanded hours compared to most patient eligibility and enrollment services. We have on-site Patient Advocates available at a minimum of 12 hours/day, 6 days/week, helping to ensure your patients find support when they need it.

Furthermore, we want to improve the patient experience with consistent communication which includes follow up with email, SMS text, and phone calls. Rather than waiting for (potentially upset) patients to call you, we reach out to them before they receive a complex bill that leads to anger, frustration, or bad debt for your organization.

Financial Education


Our Patient Advocates provide financial education to patients by counseling them on the financial aspects of their healthcare and their options for funding it. This includes informing them of government and/or charitable programs for which they may qualify, aiding them in the application process for health coverage and/or financial assistance, and helping them understand their health benefits and patient responsibility.

In addition, our Patient Advocates assist patients with resolving their patient accounts (for example, by collecting their ER co-pay and/or any prior balances, or by setting up a patient payment plan). Our pre-arrival workflow solution can also estimate patients’ out-of-pocket costs in order to prepare them for their financial responsibility.

A Patient Advocate assists a patient, and the blog title appears – The Keys to Increasing Patient Collections: Patient Communication & Financial Education

A proactive approach to increasing patient collections involves two key elements: patient communication and financial education.


Increasing Patient Collections with EligibilityAdvocates


EligibilityAdvocates’ services can eliminate patients’ out-of-pocket costs or leave them with a reduced and more manageable portion of their bill to pay. Plus, patients who understand their health benefits and financial options, medical bills, and patient responsibility are much more likely to make their payments.

Proactive patient communication and financial education will lead to greater and faster reimbursement from patients – and improve patient loyalty as well!

An on-site patient eligibility service gives your patients the opportunity to meet face-to-face with an experienced Patient Advocate who can provide personalized education and empower your patients to navigate the financial complexities of their healthcare. And all our services are free to the patient as we are contracted at a performance-based rate with each healthcare facility.

Contact us today to learn more about our proactive approach to increasing patient collections.


By Stephanie Salmich

A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

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EligibilityAdvocates Blog

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

Helping Uninsured Americans Access COVID-19 Testing and/or Treatment

Posted on Monday, August 17, 2020

Updated Friday, August 28, 2020: The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020.

Providers still have time to apply for aid through the CARES Act Provider Relief Fund. Below you’ll find important information about this program that can help providers recover revenue lost to the COVID-19 crisis and help uninsured patients avoid unexpected medical bills related to coronavirus testing and treatment.

Information for Providers


The federal government has allocated $175 billion to the Provider Relief Fund (PRF) to be distributed to qualified health care service and support providers for:

  • Appropriate expenses
  • Lost revenue due to COVID-19
  • Helping uninsured Americans access COVID-19 testing and/or treatment

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion, and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) appropriated $75 billion, to this program. The program is administered by UnitedHealth Group through a contract with the Health Resources & Services Administration (HRSA).

Payments from the Provider Relief Fund do not need to be repaid by providers who comply with the program’s terms and conditions.

Information for Uninsured Patients


According to HHS.gov: “Providers who participate in and are reimbursed from the HRSA COVID-19 Uninsured Program are not allowed to “balance bill” individuals who do not have health care coverage (uninsured).”

If you are an uninsured patient and you receive a bill for COVID-19 testing and/or treatment services which shows that a portion of the bill was paid for by the Health Resources & Services Administration (HRSA), you should contact your healthcare provider as you may not be responsible for the balance.

However, if your provider did not participate in the HRSA COVID-19 Uninsured Program or the care you received was not eligible for reimbursement from the program’s funds, you may be responsible for payment.

Applying for Reimbursement Through the CARES Act Provider Relief Fund


 

 

A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

UPDATE: PROVIDERS – The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020 to apply for Phase 2 General Distribution funding from the CARES Act Provider Relief Fund.

The deadline to apply for Phase 2 General Distribution funding has been extended to September 13, 2020. Providers should check the HHS.gov website for the latest updates on deadlines and requirements.

Key conditions for reimbursement from the Provider Relief Fund include:
  • Screening patients for health coverage to ensure they are uninsured.
  • Accepting the payment provided from the fund and refraining from further billing the patient.
  • Submitting to a post-payment audit.
  • Confirming that COVID-19 is the primary diagnosis (except in the case of pregnancy).
Additional points to keep in mind:
  • Reimbursement is generally at Medicare rates and payment is dependent upon available funding.
  • Qualifying health costs and services such as COVID-19 testing, office visits, telehealth, non-emergency transportation, and more, with dates of service/admittance on or after February 4, 2020, are eligible for reimbursement.
  • Claims cannot be repealed or reprocessed after submission.
  • To submit claims electronically, providers need a clearinghouse or similar relationship.
  • Providers must attest that the information submitted is correct (billing companies/revenue cycle vendors can attest to the accuracy of the information for the provider).

EligibilityAdvocates can help providers apply for reimbursement from the CARES Act Provider Relief Fund, navigate regulatory flexibilities related to COVID-19, and screen patients for insurance coverage.

Contact us for more information on the CARES Act Provider Relief Fund or to get started on the application process before the deadline.


By EligibilityAdvocates

A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Why Outsource Patient Eligibility Services?

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EligibilityAdvocates Blog

Why Outsource Patient Eligibility Services?

Posted on Thursday, July 30, 2020

An on-site patient eligibility service can significantly improve patient experiences, increase self-pay conversions, and reduce account cycle time. For the best results, patient eligibility services should be performance-based and you should choose a vendor who can provide both on-site patient advocates and cutting-edge technology.

Here are just a few reasons to outsource patient eligibility services:


A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Outsource patient eligibility to maximize
patient advocacy and reimbursement.

Establish a Culture of Patient Advocacy

Show your patients and everyone who belongs to your organization that your facility values and is committed to patient advocacy. The presence of a patient eligibility and enrollment service, on site and at no cost to patients, will do just that.

This service supports patients by:

  • Finding insurance coverage and/or enrolling them in health plans.
  • Identifying financial assistance opportunities and handling the application process for them.
  • Reducing their medical expenses.
  • Helping them navigate the financial aspects of their healthcare through financial counseling and education.
  • Alleviating patient financial stress and confusion.
  • Increasing patient engagement with one-on-one, in-person interaction.
  • And more.

However, the help that an internal eligibility team can provide is often inhibited by their limited hours. Most facilities’ eligibility employees work a typical 9:00 AM to 5:00 PM schedule, whereas EligibilityAdvocates’ outsourced services are available on site, including in the Emergency Department, at a minimum of 12 hours a day and 6 days a week (and up to 24 hours/day, 7 days/week – based on peak analysis). This significantly extends patients’ access to support.

The more support you offer your patients, the bigger impact you can make on your entire community’s economic outlook. Our patient eligibility services help patients and healthcare facilities financially; plus, we create job opportunities because we hire patient advocates from your local community to fill all our on-site positions.

Maximize Patient Advocacy & Reimbursement with a Team of Experts

When you outsource patient eligibility and enrollment, you can ensure your patients are served by patient advocates who specialize in this service and all the rules and regulations that impact it.

State and federal laws, as well as individual health plan and financial assistance program requirements, change regularly. And waivers are often enacted when national emergencies like the COVID-19 crisis occur.

EligibilityAdvocates monitors all policies and guidelines that determine whether a patient will qualify for assistance, what the patient must do to apply, and how your reimbursement will be affected. You and your patients don’t have to keep track of all these moving parts or risk missing a detail that results in a denied application or claim.

Our expertise also covers out-of-state Medicaid, denial prevention, and follow-up on unpaid/underpaid claims.

Utilize the Vendor’s Technology

In addition to patient advocates’ extensive knowledge and compassion, an outsourced patient eligibility service can bring innovative technology to the table as well.

At EligibilityAdvocates, we equip our patient advocates with technology that enables mobile patient screening, such as at bedside or in the field. This includes convertible laptops/tablets, HL7 for real-time notes, electronic forms automation software, data encryption in transit and at rest, intermediate saves of information, and photo capture for documentation of driver’s licenses, insurance cards, etc.

We also supply our clients with customized dashboards and reports that deliver near-real-time transparency and alerts. Plus, our pre-arrival workflow solution streamlines financial clearance and automates many tasks for Patient Access.

All our solutions are HIPAA-compliant and will adhere to your organization’s specific procedures and compliance standards.

Reduce Uncompensated Care and Improve Your Revenue Cycle

Partnering with a patient eligibility and enrollment service provider will reduce your write-offs and A/R days. When patients obtain health coverage and/or financial assistance, you get reimbursed at higher rates. And, the face-to-face meetings between patients and patient advocates result in higher conversion rates, increased point-of-service payments, and the establishment of patient payment plans.

When you choose EligibilityAdvocates, we will pursue every possible source of funding for each patient account – so your organization will always be the “payer of last resort.”

You’ll also improve your revenue cycle with the benefits of our pre-arrival workflow solution, which prevents integrity issues and errors that would otherwise cause payment delays, denials, underpayments, and rework.

Experience a Greater Return on Investment

Your ROI will be much higher when you outsource patient eligibility services in comparison to managing this work internally.

Costs accrued by in-house staff include payroll and benefits, hiring and (ongoing) training expenses, office space, and equipment (phones, computers, printers, desks, etc.). You’ll need to allocate money, time, and resources to these employees whether their performance earns it or not.

In contrast, EligibilityAdvocates offers contingent fee pricing, so you’ll only pay us a percentage of the reimbursement we collect, and you won’t have to worry about any of the typical labor costs an internal team would necessitate.

Keep Your Focus on Patient Care: Outsource Patient Eligibility Services


EligibilityAdvocates can handle all aspects of patient eligibility and enrollment for you so that your teams can devote their time and resources to providing quality patient care.

Contact us to learn more about how we can lower or eliminate your patients’ out-of-pocket costs and improve your revenue cycle.

Strengthen the financial situation of all stakeholders in your organization – outsource patient eligibility services to EligibilityAdvocates today.


By EligibilityAdvocates