Learn how financial advocacy can help reduce health equity disparities by ensuring equitable access to healthcare services for all.
How Financial Advocacy Can Help Solve Health Equity Disparities
Blog Introduction:Poor health outcomes due to disparities in healthcare, often based on socioeconomic factors like race and income
SCHFMA Presentation
Palm Beach Gardens FL, October 29th 2022. Monique Lappas, Founder, and Chief Executive Officer, of Qualify Health along with Lavonda Cravey, the VP of Revenue Cycle of Coffee Regional Medical Center presented at the South Carolina Chapter of the Healthcare Financial Management Association’s (SCHFMA) Fall Institute Conference held from October 26th through October 28th.
The conference was held at The Westin Poinsett Hotel in Greenville, SC.
The event was attended by over 120 hospital staff and executives from healthcare systems across South Carolina, as well as other industry representatives.
The topic of Mrs. Cravey’s and Ms. Lappas’ presentation was “Mission Impossible: How CRMC Grew Revenues and Brought their Patients to Tears (OF JOY!)”, in which they presented the CRMC case study of the impact that Qualify Health’s software and service solution has had on both patient financial satisfaction, patient outcomes, additional revenues, and bad debt reduction.
The association of South Carolina Oncology Managers is a non-profit professional organization that provides access for oncology practices to quality leadership development through continuing education, networking, and business improvement opportunities. Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.
ACCC Conference Attendance
West Palm Beach, FL— October, 12th 2022. Monique Lappas, Founder and Chief Executive Officer, Kapra Lott, Chief Business Development Officer and Kelly Sanders, Chief Operating Officer represented Qualify Health at the recent Association of Community Cancer Centers at their 39th National Oncology Conference.
The conference was held at the West Palm Beach Convention Center , in West Palm Beach FL
The event was attended by over 200 representatives for oncology provider practices, hospitals and industry.
The Qualify Health booth drew participants to their booth, who enjoyed the espresso and cappuccinos on offer at the booth, from as far away as Seattle, WA and North Dakota, all the way through to local Florida based practices. The conversations ranged from the prior authorization services and overcoming internal hurdles at understaffed practices, through to the financial and patient benefits of a wide-ranging and robust financial advocacy service.
The Association of Community Cancer Centers (ACCC) is a powerful community of more than 28,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide.
Founded in 1974, ACCC brings together healthcare professionals across all disciplines in oncology to promote quality cancer care. It is estimated that 65 percent of the nation’s cancer patients are treated by a member of ACCC.
Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.
How to Optimize Prior Authorization: Tips and Tricks for Providers
MT: Tips & Tricks for Physicians to Optimize Prior Authorization
MD: Prior authorization burdens physicians and impacts care. Use PMS and EMR systems to optimize prior authorization, manage denials, and eliminate disconnect.
Introduction
The wait for a prior authorization to be approved can cause patient anxiety and limit their care. However, from the providers point of view, the main focus on the prior authorization is getting it approved so that you can be reimbursed
Managing the patients emotional response to the prior authorization waiting gain can be less stressful if you include a strategy to work with the patient, and communicate with them, setting clear expectations. Implementing these conversations as part of your workflow and optimizing your prior authorization process with a much more streamlined process can result in two outcomes:
- Lowered patient anxiety
- Faster time to treatment
- Improved financial and operational efficiency for your practice
Tips to Optimize Prior Authorization
The process of obtaining prior authorization involves numerous manual steps and parties, resulting in errors. Lengthy medical reviews necessitated by prior authorization may delay care and create confusion for physicians and patients.
You can reduce the time required to treat a patient by automating the entire prior authorization procedure as soon as possible in the revenue cycle. It reduces the likelihood of errors occurring and the quantity of labor that must be performed manually.
Let’s find out the useful tricks to optimize prior authorization.
Utilize Your Electronic Medical Records (EMR) Systems
Start by maximizing the huge investment that almost all providers have made in their EMR’s.. By better utilizing your reporting functionality, you will open up the ability to better track your prior authorizations and where they are in the chain of: Submit / Approved / Denied / Appeal. These reports must, at the minimum, show the date that the authorization is needed and where it is in the process. However, having the report will be of no use, unless you have a set of eyes on it each day, and ensuring that follow ups are occurring, as needed in order to ensure the PA is complete before the patients appointment.
Work on Denial Management
Denial are a burden, but they should also be considered as a learning opportunity. Understanding the cause of your denials will help you prevent them in the future and ensure that future prior authorizations include the necessary documentation to prevent a reoccurrence. Utilizing a reporting system that gives you insight into what transpired will allow you to identify patterns. The next step is collaborating with internal and external expertise that will allow you to create a system that can capture the necessary information in the authorization submission process.
Know and Track your Policies
Most payers put their coverage rules online, they are transparent and accessible. It is important that you continue to monitor revisions and yet keep old policies. The importance of keeping historical policies on record mean that you have access to it, in cases of the need to If a payer wishes to appeal a 2021 rejection, they must use a 2021 policy, but they typically don’t know which one. However, by maintaining historical emails, bulletins, and other insurance-related documents, you have the ability to review them when fighting a denial.
Outsource Prior Authorization to Experts
Given the time and expertise needed for successful prior authorizations, experts are needed. However, because this is a ‘cost center’ practices are induced to assign their lowest cost and lest experienced employee to this role. It will take longer and may lead to errors. In many cases, making the choice or using an outsourced service provider will save your medical facility money over time, and ease the stress of the prior authorization process. Further, as prior authorization specialists are constantly focused on ensuring that they stay updated on new policies and regulations, it ensures that you are always up to date with the documentation and information that you need to submit.
ASCOM Presentation
Columbus SC— September 15th, 2022. Monique Lappas, Founder and Chief Executive Officer, , of Qualify Health presented at the Association of South Carolina Oncology Managers (ASCOM).
The conference was held at Columbia Metropolitan Convention Center , Columbia SC
The event was attended by over 40 representatives from some of South Carolina’s leading Oncology Providers, as well as other industry executives.
The topic of Ms. Lappas’ presentation was “Growing Your Revenues and Bringing Your Patients to Tears (OF JOY!)”, in which she presented case studies of the impact that Qualify Health’s software and service solution can drive financial advocacy, increased advocacy dollars, improved patient satisfaction and the company’s AI-Driven Prior Authorization platform to solve the increasing burden of Prior Authorizations.
The association of South Carolina Oncology Managers is a non-profit professional organization that provides access for oncology practices to quality leadership development through continuing education, networking, and business improvement opportunities
Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.
Four Tactics to Manage Patient Healthcare Costs
Introduction
Imagine if America’s government had an extra $1.3 trillion each year? Imagine how many poor and homeless people you could help, how much infrastructure could be improved, and how much money could be poured into educational and social care programs. According to government spending reports, the country could reach this type of saving it was to just bring down healthcare spending to that of comparable countries.
If we want healthcare spending and quality in America to be on par with the rest of the industrialized world, we need a fundamental shift in our approach to healthcare.
Below, we outline four distinct approaches exist for kickstarting this endeavor.
- Payment Plans
- Mail Order Pharmacy
- Technology to drive Continuum Care
- Helping patients understand Health Insurance Jargon
Patient Payment Plans
When patients have difficulty finding the means to pay for their health care, physicians are left to shoulder the financial burden. Their response is usually to send the outstanding monies to a collections agency without first trying Payment Plans. If Providers became more familiar with employing payment plans to assist patients they would bring improved patient satisfaction and improved revenue and payment metrics! As out of pocket costs continue to rise for patients, payment plans will become an essential method of assisting them in paying for their treatment, over time, and in smaller quantities.
Mail Order Pharmacy
The primary function of a “mail-order pharmacy” is to mail prescription medications to patients. Patients who fill their prescriptions through mail-order pharmacies, which are usually owned, or managed through their health or prescription benefit plan reduces the patient’s out of pocket costs, as the insurance plan offers to cover some of the copay costs as an incentive. Patients who use mail-order pharmacies are also more likely to be compliant, as their medications are delivered to their homes and usually in 90-day supplies. So in addition to being cheaper, it is also more convenient and they have multiple months before they need to refill.
Technology to drive Continuum Care
Technology can provide patients with more options, such as receiving care in a less stressful environment. Since the Covid pandemic, patients are becoming increasingly comfortable with the use of telehealth and mobile apps to access care. These technology options meant that they can avoid visiting out-of-network medical facilities, which place an increased cost burden on the patient.. Further, using technology can also promote patient compliance and make scheduling more efficient, reduce no-shows and more efficiently manage their providers scheduling. All of these factors allow health systems to save money over time.
Helping Patients Understand Health Insurance Jargon
It is crucial that patients understand key aspects of their health insurance. Words like “Deductible”, “Max out of Pocket”, “Copay”, “In-Network”, “Out-of-Network” are a jungle of insurance that much of the country doesn’t understand. Healthcare advocates can help patients with this terminology so that they can learn that timing of their expenses can make a big difference to their overall costs (for example, if they have hit their deductible, then make sure any expensive procedures occur before the end of the year).
Conclusion
The cost of health care is out of control for most Americans, and when patients can’t afford their care, they either don’t receive it – causing major impacts in the care continuum and hurting hospital’s value-based care metrics, or become unable to pay their bills, impacting a provider’s revenue and their credit scores when they are sent to collectsion.
Implementing technology that helps patients adhere to their treatment plans is one option to save patient costs and improve efficiency. Payment plans are also vital for assisting patients in paying for therapy. It is also essential to communicate health coverage and health insurance jargon with patients to help them manage healthcare costs. To learn more about helping patients manage healthcare costs, get in touch with Qualify Health, we are dedicated to improving healthcare finances.
Manufacturer Copay Assistance Programs
What is a Copay Assistance Program?
As healthcare costs continue to rise, patients are looking for ways to save on medication costs. Providers want to make sure they get compensated for any patient out-of-pocket expenses due to them. When insurance is not enough to cover the total cost, patients struggling to afford expensive drugs turn to Manufacturer Copay Assistance Programs or Copay Cards to help with the out-of-pocket expenses. Pharmaceutical companies typically offer these programs. The program’s purpose is to help people with commercial or private insurance cover their deductibles, copays, and co-insurance directly related to the cost of their prescription drugs.
How do Copay Assistance Programs work?
Copay Cards reduce the total out-of-pocket expenses for the patient. Once approved for the program, the patient’s insurance is billed first and covers some of the drug’s cost, then the manufacturer covers most, if not all, of the remaining out-of-pocket expense.
How to apply for a Copay Assistance Program?
If your physician practice or specialty pharmacy does not partner with someone like Q Consulting Services, then the patient can access Copay Card programs through the manufacturer’s website. To sign up for the program, they will register online, or call the program to enroll. Once you are enrolled, you are provided with your member information and possibly a credit card to use at your pharmacy or provider’s office– this varies among programs.
If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS) , we will sign up the patient and maintain their membership, and give you and the patient any information they need.
What are the requirements or restrictions?
For most Copay Card Programs, there are two main requirements:
1. The patient must have commercial or private insurance.
2. You cannot have government health insurance, such as Medicare, Medicare Advantage Plans, or Medicaid.
How to receive reimbursement for out-of-pocket expenses?
There are three possible scenarios:
1. The patient is filling their prescription (e.g., Humira) at the provider or hospital-owned specialty pharmacy. The pharmacist will process the patient’s insurance as the primary payer and the copay card as the secondary payer. The Copay Card Program may cover the out-of-pocket expense in its entirety, or the patient may be responsible for a tiny portion – generally around $5.
2. The patient is receiving an infusion (e.g., Herceptin, Stelara) at an out-patient facility. The facility will bill the primary insurance for the drug. Once the insurance company pays its portion, the explanation of benefits (EOB) will indicate the patient’s out-of-pocket expense. The patient is then responsible for submitting the EOB to the program. When the claim is approved, the program will mail a check or upload the reimbursement to a credit card.
3. QCSS can manage the entire reimbursement process, from electronically receiving the EOB as soon as the billing occurs, to and ensuring that the charge is loaded on the copay card and making sure the physician office is paid by either managing check requisitions or running the copay cards through your POS.
How do patients and healthcare professionals benefit from Copay Assistance Programs?
Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.
Q Consulting Support Services specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.
Foundation Assistance for Chronic or Life-Altering Diseases
How to find Foundation Assistance for patients
Foundation Assistance for Chronic or Life-Altering Diseases
Foundations offer financial assistance to those suffering from Chronic or Life-Altering Diseases when insurance is not enough to cover the treatment. Foundations help fill the gaps by assisting patients with their out-of-pocket expenses.
What is Foundation Assistance, and Who offers it?
Non-profit organizations like The Leukemia & Lymphoma Society, Healthwell Foundation, and the PAN Foundation, to list a few, provide financial assistance to patients in need. These foundations offer specific disease funds and award assistance to patients via grants. The grants awarded may cover copays, deductibles, insurance premiums, co-insurance and may help with travel or household expenses.
Who is eligible for Foundation Assistance?
Available funding is disease-specific – you must be diagnosed with the disease, be actively receiving treatment in the United States, have insurance covering the medication and therapy, and fall within a certain percentage of the Federal Poverty Level Guidelines (FPL). Unlike Manufacturer Copay Assistance Programs, Foundations allow applicants to have Federally Funded insurance like Medicare and Medicare Advantage plans.
If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS), we will enroll all qualified patients, maintain their enrolment, and manage the entire billing and collections process.
How to apply for Foundation Assistance?
Disease fund availability is dependent upon whether there is sufficient funding available. Funds open and close daily, making the application process more difficult than other financial assistance programs. If a fund is accepting applications, you should apply immediately.
Step 1: Gather Information for the application.
- Demographics (including Social Security Number)
- Diagnosis
- Estimated household financial income
- Insurance information
- Pharmacy contact information
- Treating physician contact information
Step 2:
- Apply online or over the phone.
Alternatively, QCSS can manage the entire process, from enrolling patients as soon as a fund opens and helping them manage their financial paperwork to ensure all claims are submitted and reimbursed promptly.
How much financial assistance can I receive, and how is it paid out?
The award levels range from $100 to over $10,000 per applicant, depending on the fund. The full grant amount is allocated over one year and reimburses for services and treatments rendered during this period via the fund’s reimbursement process.
Keeping your grant active
Foundations want to ensure that grants are being used by those actively receiving treatment and in need of financial assistance. Many foundations require initial reimbursement requests to be submitted within a specific time frame and do not allow extended periods of inactivity, or the awardee could lose the grant completely. The time frames vary between 90-120 days.
Q Consulting Support Services specializes in managing Foundation Grants for our clients. We actively monitor Foundation sites to apply for our patients as soon as a fund opens up. Additionally, we ensure that all reimbursement requests are submitted timely so that our patients do not lose their funding and may continue to pay their providers for services rendered.