Eligibility Behavioral Health Case Study

Case Study | September 19, 2022

Eligibility and Enrollment Services Result in Greater Reimbursement, Patient Retention, and Community Outreach for Behavioral Health Group 

Increasing Financial Burden

Patients’ financial burden for care has grown significantly, with the average annual insurance deductible increasing 79% in the past 10 years.¹ Underinsured or uninsured patients face an even greater burden, and the impact of COVID has worsened the financial burden for both patients and providers. This is true for facilities of all types, but behavioral health facilities have been especially hard hit. In a survey on COVID pandemic effects, results showed 52% of behavioral health providers saw an increase in demand for services, yet 54% have closed programs, and some have lost nearly 23% of their annual revenue.²

The Challenge

A large mental health services organization in the Midwest, serving multiple outpatient clinics in nine counties, wanted to improve access to care for self-pay clients. With limited resources to work with the uninsured or underinsured patient population, patient volumes were rising and many of the organization’s locations were not receiving payments for treating these patients. Leadership explored an outsourced solution based on the recommendation of a local mental health board.

The Solution

Elevate Patient Financial Solutions was selected for its ability to provide a comprehensive patient-friendly Medicaid and Social Security Disability screening process and quick turnaround of approved applications. ElevatePFS expert teams were able to efficiently work with the increasing volume of uninsured and underinsured patients. Using specialized technology and decades of service-specific expertise, ElevatePFS helped patients find the right assistance programs to ensure all potential coverage options were identified. A close partnership with regular communication on both sides ensured continual progress and success.

“The primary goal is to get folks enrolled and approved for Medicaid. ElevatePFS has relationships with local government agencies, and they saved the organization a significant amount of money over the years. ElevatePFS was excellent at getting people the benefits they are eligible for.”

— Executive Director of Mental Health Services Organization
 

Results

ElevatePFS eligibility and enrollment services implementation resulted in an average conversion rate of 85% and increased reimbursement for the provider, which allowed them to provide more services to the community. Patients also benefited from reduced out-of-pocket expense and greater access to care. The result was a win-win: an improved bottom line for the provider and a better healthcare financial experience for the patient.

“The primary goal is to get folks enrolled and approved for Medicaid. ElevatePFS has relationships with local government agencies, and they have saved the organization a significant amount of money over the years,” the executive director of the mental health services organization said. “We track referrals, enrollments, and approval times quarterly. I have also been able to track the claims the organization would have been responsible to pay had we not received their approval quickly. ElevatePFS was excellent at getting people the benefits they are eligible for.”

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The Elevated Difference

Another noteworthy win for this provider was significant results for the organization’s 24-hour crisis center. ElevatePFS was able to initiate contact with patients after they left the crisis center to complete their Medicaid applications. This increased patient retention by 18% and helped them continue their treatment plan to get the care they needed. Additionally, it enabled the center to expand outreach in the community, resulting in more patients being served.

1. “2020 Employer Health Benefits Survey,” Kaiser Family Foundation, October 2020
2. “Demand for Mental Health and Addiction Services Increasing as COVID-19 Pandemic Continues to Threaten Availability of Treatment Options,” National Council for Behavioral Health, September 2020