RPM's response to Legislation

 

 

The Tax-Exempt Hospital Responsibility Act will mandate that hospitals provide uncompensated care to poor or uninsured patients in an amount that is at least eight percent of their total operating cost. Most Illinois Hospitals have very generous financial assistance programs, but many still struggle to meet internally set goals for financial assistance. Many facilities have difficulties meeting these goals due to their inability to obtain supporting documentation and collateral verification prior to allocating. In addition to reevaluating your financial assistance policy (which many of you have already done), meeting the new goals for financial assistance may require that hospitals take a more proactive approach to identifying and processing potential financial assistance at every stage of the revenue cycle.

 

RPM provides services that are designed to maximize recoveries from a variety of Entitlement programs and insure the early identification and processing of financial assistance applications.  RPM offers:

 

Ø      Entitlement Programs and Services- This includes state Medicaid, county assistance programs, §1011 reimbursement as well as Department of Mental Health reimbursement.

 

Ø      Proactive Financial Assistance Application Processing-RPM’s Reimbursement Analysts are fully trained in all aspects of Entitlement programs, as well as hospital-sponsored financial assistance programs.  After the initial bedside interview, RPM representatives are prepared to make a recommendation as to the appropriate disposition of the “uninsured” account.

 

Ø      Financial Counseling Services-all RPM representatives, both on-site and office-based, are fully trained in completing thorough patient interviews and fully understand all available Entitlement programs.  RPM evaluates a patient’s financial condition and distinguishes a patient’s “inability to pay” from “unwillingness to pay” at all stages of the revenue cycle.

 

Ø      Patient Outreach-RPM provides highly trained staff that are able to visit the patient at their home in order to complete interviews and obtain required documentation.  RPM patient outreach specialists are also able to contact various community resources, face-to-face, in order to complete the appropriate application and obtain required documentation.

 

Ø      Financial Counseling and Patient Inquiry Outsourcing-RPM is able to assume all patient inquiry and financial counselor activities.  This program insures consistent and thorough application of financial assistance and collection policies, while at the same time reducing hospital resources dedicated to these processes.  Benchmarks for these types of engagements include meeting the facility’s internal financial assistance goals.

 

 

The Hospital Fair Billing and Collection Practices Act will, if enacted into law, prompt a review of many of the hospital’s current policies and procedures. Hospital’s will be required to carefully scrutinize existing collection procedures and policies. RPM is a company that has specialized in healthcare receivable management for over 20 years, as such we are uniquely positioned to continue assisting healthcare providers in meeting all potential regulatory requirements.

 

Ø      RPM was created, and is currently operated, by attorneys who are specialists in all aspects of healthcare reimbursement as well as processes related to the revenue cycle

 

Ø      RPM staff is fully trained in and compliant with the Fair Debt Collection Practices Act (FDCPA), HIPPA as well as the Fair Credit Reporting Act (FCRA).  Because of this, RPM maintains an excellent record of minimal regulatory and patient  complaints

 

Ø      RPM utilizes various tools, such as recovery scoring, credit profiles and verification of assets, to identify those self-pay accounts that can be pursued for collection.  If an RPM specialist identifies that a patient lacks the ability to pay, collection efforts are suspended and the patient is evaluated for potential Entitlement programs or hospital financial assistance.

 

Ø      RPM has incorporated various systems and processes to insure regulatory compliance, including, but not limited to;

 

§         Inbound and outbound call recording

§         On-going training of staff, especially in the areas of customer service, regulatory compliance and patient interview technique

§         All patient complaints are logged, documented and reviewed for follow up action by senior management

 

Ø      All recommendations for legal action are reviewed by an attorney, before being presented to RPM’s clients.  Recommended legal action (either initial lawsuit or post-judgment recovery action) is always made in writing and fully supported by collateral documentation and information