HFMA Philadelphia Chapter Newsletter

As competition increases among companies specializing in third party screening and eligibility, outstanding service is more than something to be strived for, it’s an absolute necessity. Health care providers have a lot of choices available, and if one company can’t deliver, another can easily step in to fill the void.

This is not to say that existing relationships between providers and their eligibility and recovery partners aren’t valuable, but in the face of mounting government pressure to control costs, every dollar counts. Companies that can streamline processes while increasing cash payments from such programs as Medicaid, Medi-Cal and AHCCCS, have a definite edge. That said, exactly what does distinguish companies that provide excellent service from those whose service is just adequate? A number of things:

Keep your eye on the money.
Maximizing cash intake is the main reason your customers partnered with you in the first place, but in the process of delivering other services, an eligibility and recovery company can lose sight of this fact. This is especially true when you consider the broad spectrum of services providers have come to expect. Jess Martinez, Business Office Director at Northwest Medical Center, acknowledges that revenue enhancement is one of the most important, if not the most important aspect of the relationship.

"We’re looking for responsiveness to facility concerns and issues, excellent customer service, no delays in the company's processes that result in a delay in reimbursement

for the facility, and finally, a tremendous improvement in the revenue cycle as a result of their work. My facility has experienced this with our eligibility and recovery partner in that we have seen a 100 percent cash turnaround with regard to Medicaid collections and a 200 percent increase in Medicaid application approvals.”

Keeping the revenue stream flowing is obviously job one, but other factors also come into play when great service is the goal.

Be very good at what you do.
As providers become more aware of their options, the need for eligibility and recovery companies to provide added services increases. Larry Roberts, co-founder of Integrated Health Management Services, believes companies must be able to respond to changing demands within the industry.

“Providers are expecting more and more. What we are finding is that they feel more comfortable asking us to take on additional responsibilities. We are often asked to handle deficiencies that are inherent in their infrastructure when the client lacks the resources to correct those problems on their own.”

Maintaining an organization that consistently exceeds both provider and patient expectations requires experienced administrators and industry-savvy collections and field staff members. Hiring people with direct experience at the county or state level brings a unique insight into how best to expedite the application process.