Invicta Gets Real on Primary Enrollment in 2021
The field of healthcare revenue cycle management continues to rapidly change as technology and pressure from external forces create opportunity for greater impact with both patients and their families, as well as the hospital facilities that care for them. We asked our Vice Presidents of Operations (and resident Primary & Secondary Enrollment Ninjas) Melissa Lochman and Tiffany Echevarria to weigh in on what they are seeing in the Enrollment space these days.
What have you seen, learned, and coached with your Enrollment teams in the past year?
We already knew that communication and education make a material impact in addressing Medicaid, SSI/SSDI and Social Determinants of Health (SDoH) with uninsured patients. We learned that engaging and interacting with uninsured patients at all points of registration and post-discharge is critical to achieving higher screening and enrollment outcomes. Coordination among entities (Patient Access, Social Workers, Case Management, & Government agencies) all committed to the patient’s application success was an area of focus. We coached our Enrollment Teams on how to best leverage our SMS outreach and electronic signature technology. Modern technology enabled connectivity systems are no longer a “nice-to-have” resource. They are an absolute necessity.
Our Enrollment teams have demonstrated superb performance this year. And, yes, we have had challenges: Changes in client protocols, unexpected resignations, staffing modifications, adoption of new performance tools, and sporadic patient volumes. As the entire Healthcare industry continues to trend to a higher percentage of minimal patient contact engagement, our team members who deal with patients and their families on the front lines have had to adapt. For example, we’ve seen a record number of isolation cases in 2021 due to COVID. Our Coverage Consultants and leadership team have had to think critically about purposeful ways of engaging hospitalized patients.
It is important that we continue to identify and bring new solutions and ideas to the table. We have invited and challenged our team members to be a part of how Invicta continually refines best practices in all Operations. This involves everything from daily interactions, participating in surveys, as well as suggestions of solutions we can implement to streamline the patient engagement and enrollment process.
What are some examples of patient feedback you have received this year?
We’ve seen some truly heart-warming patient responses this year. Here are a few highlights:
“I want to thank your company and specially (Invicta Employee) for the way he treated my mom’s case. She is an immigrant from Spain and in need of continuous cancer treatment. The referral he sent to Moffitt Clinic is saving my mom. They called her the very next day and she is now in treatment. Bless your company and all the people like (Invicta Employee).”
“Let me first start off by saying (Invicta Employee) is very pleasant and very easy to work with. When my case was about to close and close to being denied, she did everything in her power to make sure that we were able to be approved.”
“I’m so proud of how hard (Invicta Employee) worked on the account for a young mother with limited resources. She met with the family to get needed documents, processed 14 pages of bills successfully for Medicaid approval, and even went the extra mile to help the family get free pampers for the baby, referral for rental assistance, extra food, and available services since her husband has been in the hospital for more than two months. This is why we do what we do!”
These are the kinds of comments that inspire and fuel individuals in our organization at all levels.
Do you handle Disability?
Yes, we do! Invicta’s experience with both SSI and SSD processes is extensive. We know the process is tedious and requires intense follow-up and submission of copious documentation. We are very familiar with SSA and its penchant toward denying claims early. We know how to appeal denials along the way and historically obtain a high success rate of conversion to SSI. If qualifications for Medicaid or SSI are not met by the patient, we fully explore all other payer sources to match their qualifications to other programs for which they may be eligible.
For example, we understand that cancer patients, depending upon the severity and stage of their illness, may be presumptively eligible for coverage. Invicta identifies and assists those patients to obtain SSI and SSD by capitalizing on the accelerated timelines to gain approvals. Our staff quickly gathers and provides the documentation to assure early coverage.
Do you work Medicaid and County programs only, or do you look for additional programs for which a patient might be eligible?
Invicta Health Solutions works with hospitals and healthcare systems across the country to identify and secure all available coverage options for your self-pay patients. Our patient-centric approach provides a comprehensive collection of services that directly support your patients while also improving your ability to collect revenue for the services you provide. A next generation Enrollment solution encompasses many more payer sources than those associated with Medicaid and county indigent plans. Invicta combines industry leading technology and a new innovative approach to the traditional enrollment process. Our team will help your patients find every local, state, and federal program for which they are eligible and assist them in the enrollment process.
How do you measure success?
Invicta performs peer, management, and technical reviews for deliverables to ensure we meet or exceed performance standards and acceptable quality levels (AQLs). In the draft stage of deliverables, we apply internal controls and perform management reviews. We take corrective actions using a formal problem/issue review. Our team performs these quality review practices ensuring data reporting meets or exceeds your quality standards. Invicta measures quality through many factors including but not limited to: Screenings; Application Submissions; Approvals; Payments Received; Cycle Times; Pending Inventory; and Filing Deadline. Client specific metrics can also be incorporated as part of the implementation process.
Key Performance Indicators we use to monitor and improve services include:
- Number of placements
- Inpatients screenings/attempts
- Days from referral to screening
- Screening Percentage of placements
- Screenings that lead to initiated and completed applications
- Days from screening to application
- Percentage of Applications Taken that are subsequently approved Days from application to approval
- Conversion Rates
- Days from approval to reimbursement
Constant, open, and direct lines of communication between Invicta employees and hospital facilities guarantee effective project management, quality control and mutual trust. We believe that face-to-face discussions are the most effective way to plan projects, resolve issues, and foster good teamwork. Consistent communications allow our managers to identify efficiencies and best practices to make certain we maintain optimum quality for our patients and clients.
Given the changes that have occurred in Healthcare over the past year and a half, how do you determine how many people need to be on-site in our facilities versus those who are remote?
We work with each client to create a staffing model dedicated solely to their accounts to meet each hospital’s needs and wants for on-site and off-site support. A customized model will give the most coverage and be the most efficient at peak times. Additionally, our back-office support and screening technologies will be diligently working to provide coverage on outpatients and discharged patients on nights, weekends, and holidays. In short, we know that on-site staffing is a collaborative process
If we are interested in Secondary Enrollment, can Invicta do that for us?
Yes, we can! Invicta’s Secondary Enrollment service is structured to secure Medicaid and other potential coverage options for displaced patients who would otherwise fall into a bad debt or charity classification. We have one clear-cut objective for our Secondary Enrollment service: the successful execution of technology enabled operational processes to accurately identify, educate, and enroll uninsured patients. We deploy a positive educational approach for the patient by clarifying enrollment misconceptions and hurdles.
Our integration of human capability with technology to simplify process can often be the difference. Our Secondary Enrollment Service clients see accelerated determination of uninsured self-pay accounts, and increased number of Outpatient & Emergency Room screenings, improved Enrollment conversion rates, and – in cases where it’s necessary – expedited progression to the Hospital’s charity care program. This results in reductions of bad debt as well as improved patient satisfaction rates.
The Invicta team leverages people, process, and technology to deliver services that positively impact the lives of patients while delivering improved financial performance to our client partners. We treat each patient with the utmost respect, creating a positive patient experience, because they are the center of our business.
Contact firstname.lastname@example.org today for more information on our Primary and Secondary Enrollment capabilities.