Eligibility Case Study

Case Study | May 3, 2022

Despite COVID-19, Large Health System Successfully Expands Eligibility Service Across 11 Facilities 

The Challenge

In 2019, a large integrated health system in the Midwest engaged Elevate Patient Financial Solutions to enhance their financial advocacy programs in three locations. The implementation was so successful, the client decided to expand these services to 11 more locations by May 2020—precisely when the COVID-19 pandemic was ramping up. Healthcare providers—especially those overseeing the revenue cycle—were already feeling the burden of the pandemic through canceled elective procedures, revenue shortfalls, and more.

Heightened restrictions prevented ElevatePFS advocates from working onsite in the hospital, which meant implementation, ramp up, and management of the project would have to be done remotely.

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The Solution

Despite the hurdles that COVID-19 presented, ElevatePFS’ Eligibility team pressed forward to continue the expansion process across the 11 locations. To overcome hiring challenges during the pandemic, ElevatePFS relied on its expansive national presence—along with a strong network of local advocates—to deploy the roles necessary for completion. Implementation would have stalled without this level of resources.

Thanks to its level of expertise, ElevatePFS established a strict escalation process with the health system’s home state: if DHS didn’t act on an open case within 60 days, ElevatePFS filed an appeal for case resolution. At a time when government agencies were overwhelmed, it was critical to ensure no applications went unseen.

Since advocates were not able to be on site, utilizing the right technology to connect with patients post-care was vital. The ability to capture the necessary signatures for approval ensured applications and submissions remained timely during an unprecedented time.

ElevatePFS’ implementation success hinged on a variety of innovative and proprietary tools, including:

1. Patient Virtual Screener: 24/7 toll-free phone screening tool for patients to instantly determine if they qualify for payor programs.

2. Patient E-Signature Capability: Facilitates remote patient signatures and accelerates application submissions.

3. Approval Eligibility Acceleration System: Allows advocates to file and easily track applications, verifications, and deadlines with on-demand status updates.

ElevatePFS’ national presence, expansive staffing resources, and innovative virtual toolkit helped the team overcome significant challenges while still meeting the project deadlines and driving incredible conversion results.

Results

Not only did ElevatePFS go live on the 11 expansion sites on time and in a completely remote environment, but the team also reached peak conversion rates within three months for inpatient cases and five months for outpatient. By the end of 2020, all locations using Eligibility services had an impressive 91 percent overall net conversion rate (Inpatient: 94percent, Outpatient: 89 percent). The leadership team from the health system was so impressed by the successful implementation process and high level of service, they now utilize ElevatePFS’ Eligibility offerings in all of their hospitals.

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The Elevated Difference

ElevatePFS’ patient-centered approach ensures each person is treated with the compassion, dignity, and respect they deserve. One of the best ways to provide value to clients is to care for their patients. Here are a few real-life examples of patient-focused care (names have been changed to protect privacy):

Maria, who was undocumented, intubated, and had tested positive for COVID-19, had been hospitalized for three straight months, leading to a balance of over $1 million. The severity of Maria’s illness and the financial concerns it presented caused stress for her and her family. Maria’s case was referred to ElevatePFS’ patient advocacy team, which immediately conducted a virtual screening and obtained the necessary signatures and documentation. The application was submitted, escalated to HFS, and approved in less than 48 hours. This alleviated the financial burden for Maria and her family. Now, they could focus more on healing and less on hospital bills.

On the verge of homelessness, Troy was in dire need of emergency food and medical services. He hadn’t eaten in over a week and didn’t have the necessary resources to complete the DHS interview to secure food stamps. Troy’s patient advocate from ElevatePFS was able to answer the interview questions on his behalf, and within three days, he was approved for medical and food assistance. Troy was in tears. He never imagined anyone would care abouthis situation in the way ElevatePFS did.