To ensure increased patient satisfaction and achieve the maximum recoveries, a multi-step eligibility process that queries on a frequent basis is important. Pronto Computing’s Self Pay Discovery product queries several eligibility sources to identify active Medicaid, Medicare, and commercial coverages. Additionally, we are able to identify inactive coverage for Medicaid and commercial plans. The inactive Medicaid can be screened for either re-enrollment in the Medicaid program or potential charity care write-off while the inactive commercial coverages can be flagged for more dedicated follow-up.

Pronto uses a combination of proprietary sources and 270/271 HIPAA transactions to identify coverage and provide eligibility information for review and claim submission. We will process pure Self Pay, Medicaid pending, SSI pending and TPL pending accounts on a weekly basis to determine if insurance coverage exists for the guarantor. Utilizing Pronto Self Pay Discovery reduces overall bad debt/uncompensated care, increases cash collections, reduces re-work, and increases overall patient satisfaction.

Below are the Self Pay Discovery results, on average, based on a Self Pay AR portfolio of $50 million. Of course, these results will vary by market.

Pronto scrubs open Self Pay accounts receivable on a weekly basis. This allows for maximum hit rates of found insurance. If the provider currently only looks based on the date of service, they could be missing future added insurance. For example, John Doe is seen at Provider A for chest pains in January and at that time is Self Pay only. John Doe later in the month of January is admitted for trauma reasons to Provider B. Provider B will most likely initiate a Medicaid Eligibility application to obtain coverage for John Doe. The Medicaid approval process may take several months to complete. Pronto will search every week to identify potential retro-eligibility coverage.

On average, Pronto has identified retro-eligibility on 30% of the volume and 35% of the dollars of the total found Medicaid coverage. This is where the Medicaid coverage was added after the date of service, but eligible back to the original date of service. Further, approximately 30% of those dollars were found after 30 days from the date of service.

State Collection Service has partnered with Pronto to deliver these results to our clients. For more information, please contact your Client Services Executive.

Since 1949, State Collection Service has provided quality collection service to countless healthcare organizations.

Through experience and innovation, State Collection Service has grown to become a tremendously credible and nationally-recognized collection agency offering services from pre-registration to bad debt. It is upon the basis of ethical behavior and a dedication to integrity that each State Collection Service employee works to uphold the company’s vision – Partnerships for a Lifetime.

*This article first appeared in “A State Collection Service, Inc. Newsletter Volume 22, Issue 3, Third Quarter 2016”