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Community Benefit: Raising the Bar through People, Partnerships and Technology. UPMC Patient Financial Services Center April Langford MedAssets Julie Kay. Overview. Objectives Community Benefit: The industry status About UPMC Environmental conditions Identifying the need
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UPMC Patient Financial Services Center
The UPMC Patient Financial Services Center was designed to assist uninsured and underinsured individuals and families in finding financial solutions for medically necessary services.
We developed our Patient Financial Services Center such that caregivers and patients can access financial services and counseling throughout the entire continuum of care.
Data taken from 1990-2011 America's Health Rankings® by the United Health Foundation.
39% Increase since FY09
18% Increase since FY09
Referrals to the UPMC PFSC occur along the entire continuum of care, and a proactive approach is taken to ensure that all uninsured/underinsured patients are identified as soon as possible.
Points of Referral
Obtain MA for Patient
Provide Financial Assistance for Qualified Patients
Point of Service
Create Effective Collection Process
After the patient is referred to the UPMC PFSC, a specialist will work with the patient to determine if they qualify for Medical Assistance, Financial Assistance or have the ability to pay. They will then work with the patient to assist in the application process and/or set up a mutually agreeable payment plan.
Pre Arrival Uninsured/Underinsured SDS and Outpatient Radiology - Combined
37% Decrease since Nov 10
Non-Emergent Uncompensated Care as a Percentage of Total Uncompensated Care
219% Increase since Feb 2010
Started Internal MA Process
Changed Referral Criteria to EXCLUDE Balances <$1000
$50,507,572 in MA cash was received
7,303 patients, or 64%, were approved for MA
Results of MA Eligibility Process
In FY11, we referred 11,522 Patients* to MA
Of those 11,440 closed applications for patients referred to MA…
85.72% FA W/Os
2,144 patients, or 52% were denied as Over Income
7.00% BD W/Os
4,137 patients, or 36%, were denied MA. Of those denied MA…
1,993 patients, or 48% were denied as Uncooperative
83.86% FA W/Os
*Includes IP and OP Referrals
**Includes Patient, Insurance, and Out for Collection Payments
7.12% BD W/Os
Over 200 More Applications Received per Month in FY 12 than FY11
15.57% of referrals to UPMC PFSC are identified through scoring
UPMC PSFC Opportunity – Bad Debt