Problem:
Clients don’t know if they have insurance or are eligible for services.
Solution:
Ask clients what insurance they have to increase possible billings to third-party payers. Research other sources of information about insurance coverage. Help clients enroll in programs for which they may be eligible.
Featured Stories
El Centro de Libertad in San Mateo County, California, implemented a practice of screening clients for health care coverage when they make their initial call. They instructed clients to bring insurance cards (if any) to the orientation group. At orientation, they scheduled appointments for clients who were interested in enrolling in MCE (Medicaid Coverage Expansion) or ACE (Access and Care for Everyone, for adults age 21 through 64 who are not eligible for Medi-Cal and Medicare programs, live in San Mateo County, and have low to middle income). The percentage of patients with insurance coverage increased from 45% to 61.5% and the percentage of clients enrolled in ACE increased from 5% to 13.4% within 6 months.
Excelsior in Spokane County, Washington, used ProviderOne, Washington’s Social and Health Services Provider Payment System, to identify other insurance coverage for clients listed in the Medicaid eligibility report. That change along with increasing their private insurance client census and raising rates increased revenue by $50,000/quarter.
Lessons Learned
- Ask clients what insurance they have.
- Help clients enroll in government programs that may cover treatment.
- Information about a client’s insurance coverage may have already been collected in government databases.
Tracking Measures
| Cycle Measure | Data Collection Form |
|---|---|
| Number and percentage of clients with third-party coverage | None |
| $ of revenue from third-party payers | Revenue by Payer Worksheet |
ActionSteps
Related Information
More Stories
Project Ninety in San Mateo County, California enrolled 113 clients in ACE (Access and Care for Everyone), a San Mateo County program for people with low to middle income, upon entry into treatment. This accounts for 100% of the clients who were eligible over a period of less than six months.