2013 Patient Assistance and Reimbursement Guide - Association of ...

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two grants: one for surgical expenses
($26,400) and one for mammography
($67,500), or 28 percent of total program
costs. As in the previous year, the
remaining costs were either reimbursed
by the Rex Healthcare Foundation or
considered charity write-offs.
Surgical Care & Surgical
Services
Patients have numerous options for surgical
management within our community.
Many surgery practices participate in
the county-wide Project Access for care,
however, capacity is limited. A few
additional resources exist for surgical
management, but are limited to breast
cancer care. Patients seeking care with
Rex Surgical Specialists (a non-Rex
Hospital business entity) are immediately
engaged in the Rex Assist program for
imminent hospital-based charges and are
also eligible for financial discounts and
payment plans, based on eligibility, for
professional fees.
Radiation Oncology
& Treatment
Our radiation oncologists are UNCemployed
physicians; therefore, patients
receive a bill from UNC Physicians &
Associates for professional fees. More
than two years ago, the charity care
process was standardized for patients
whether they received care at Rex Healthcare
or UNC Healthcare. Prior to that
time, patients had to complete two separate
applications for assistance and wait
for pending approval from both entities.
Standardizing this process has greatly
increased efficiency, patient satisfaction,
and patient compliance with care at both
institutions.
Treatment-associated costs for radiation
oncology are hospital-based charges
and are eligible for Rex Assist charity
care.
Prior to treatment, patients within
radiation oncology are also provided
with an estimated cost of care, which is
aligned with an upfront collections process.
We refer uninsured individuals or
patients with concerns about the cost of
treatment to Rex Assist and our oncology
social work team.
Medical Oncology
& Treatment
Our medical oncologists are employed by
Rex Healthcare. As such, patients are eligible
for Rex Assist for professional fees
and hospital-based treatment costs. Due
to the overwhelming cost of therapeutic
agents, financial counselors meet with
patients prior to the start of treatment to
eliminate the financial burden as much
as possible. The financial counselors
conduct an assessment to determine
insurance coverage and potential patient
liability and identify individuals who
are self-pay or uninsured (see Figure 2,
page 9).
For patients with insurance, prior to
or during the session, financial counselors
review:
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Verification of benefits
Verification of out-of-pocket cost(s)
Verification of deductible and determination
if it has been met for that
plan year.
For patients who indicate that meeting
out-of-pocket costs may be difficult,
financial counselors identify additional
assistance options, including:
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Co-pay assistance programs
Payment plans.
For those patients interested in payment
plans, our team generally adheres to
amounts per policy, but also maintains
additional flexibility to lower payments
to amounts comfortable for the patient.
For uninsured patients, our financial
counselors help them in applying for
Rex Assist (if they have not already
completed an application) and to reapply
every six months. Our financial
counselors also actively pursue assistance
from pharmaceutical patient assistance
programs.
The team tracks the assistance
that they offer to patients (see Table 3,
page 7). Not only do these metrics justify
our financial counselor positions, they
identify concrete benefits related to
ongoing financial intervention and case
management.
Professional Fees &
Hospital Charges
For medical oncology, professional fee
billing is managed within the practice.
The financial counselors review accounts
and write off the eligible amounts linked
to Rex Assist before sending the account
to our contracted billing clearinghouse.
We use our EMR to maintain a list of
individuals eligible for Rex Assist and
to generate monthly reports using the
payer source designated as Rex Assist.
Most often Rex Assist covers the full
professional fee costs. However, for those
accounts with any remaining liability, our
financial counselors work with patients to
create payment plans.
Hospital-based charges are submitted
for chemotherapy and the associated
administration and billed by Rex Healthcare
Patient Financial Services. For those
charges that have a Rex Assist payer
source, charges are written off per percentage
eligibility. Each billing location
that includes medical oncology reports
monthly on the amount of charity care.
Patients can call a toll-free number to
talk with Rex Patient Financial Services
customer service team members about
their bill, potential payment plans, and/
or resources to help manage financial
burdens. Our financial counseling team
works closely with our social work team
in this process.
Pharmaceutical Patient
Assistance Programs
After the initial consult, our financial
counselors use the following process to
manage self-pay or uninsured patients:
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Physician writes order
Chemo order is sent for authorization
Authorization staff transfer self-pay
patients to the financial counseling
team
Financial counseling team researches
available patient assistance programs
based on regimen
At the Chemo Teaching Session,
financial counselors work with
patients to prepare and sign patient
assistance applications, including
identifying and gathering the necessary
financial documents
Financial counselors complete the
application with pertinent and available
information before the Chemo
Consult with patient
At the Chemo Consult, financial
counselors review the final application
with the patient and obtain final
signature
Financial counselors submit applica-
ACCC 2013 Patient Assistance and Reimbursement Guide