Project Description

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A Top 10 teaching hospital in California improves work flow efficiency by margin of 40%, while improving Patient Experience, through implementation and utilization of USCB’s “legacy” Charity Care database and deployment of Caritas360’s dynamic eForm.

Health System “Hospital A” Demographics and Key Clinical Metrics

Ownership: Voluntary Non-Profit
Annual Net Patient Revenue: $4.4B
# of Staffed Beds: 640
# of Discharges 34,354
Billing/RCM System: EPIC Systems – Millenium
Primary System Components: Hospitals                             3

Physician Groups              7

Ambulatory Surgery Centers             6

Payor Mix: Medicare                             15%

Medicaid                             6%

Private/Self Pay/Other  79%

Problem

Under the new regulations established by the ACA in 2010, hospital organizations must meet four new requirements to qualify as a tax-exempt facility, one of which requires hospitals to implement “…a comprehensive Financial Assistance Policy which is widely distributed and clearly describes the method for applying for Financial Assistance.

In general, a hospital organization’s failure to meet the requirements of Section 501(r) with respect to one or more hospital facilities it operates may result in revocation of the organization’s tax-exempt status.

According to the most recent IRS report of 2,482 compliance reviews of charitable hospitals completed between 2014 and 2016, the IRS cited 163 (nearly 7%) as potentially non-compliant and are under further examination.  Approximately 40% of hospitals reviewed by the IRS for 501(r) compliance have received follow up requests for additional information.

Challenge

Although many of the requirements mandated by ACA were not enacted until 2016, Hospital A was already hemorrhaging under the voluminous paperwork associated with their then manual, paper-driven Charity Care Program, a key component of the IRS mandated Financial Assistance Policy (FAP).

At the time ACA was enacted in 2010, Hospital A had a simple Access database it used for entering and tracking Medical Financial Assistance (MFA) applications.  The database had minimal functionality and was essentially an Excel spreadsheet with some very limited data mining capabilities.  For the most part, even the simplest tasks required the intervention of the IS department.

Senior leadership grew impatient, regularly asking for more advanced reporting of data metrics that the database simply did not house and the Patient Financial Assistance PFA team did not have the technological know-how with which to create the requested reports.

Patient satisfaction was strained to critical levels as MFA applications went unattended for weeks and even months on end.  The PFA team was not meeting target application turnaround times, with over 3,000 MFA applications backlogged at any given time.  Paper applications and supporting documents were scattered under desks, in drawers, in spare offices…literally “everywhere”, creating a potential HIPAA violation.

The paper-driven manual process, an inadequate database/management system and heightened demands from senior leadership, all combined, resulted in a burgeoning staff and over-commitment of FTE resources just to maintain an already failing “system”.

Strategy

USCB America was challenged to develop and deliver a fully-integrated electronic Charity Care Management Solution meeting the needs of both Hospital A’s PFA Team and the hospitals Patient population.

Primary objective:  Enhance Patient and Hospital A experiences, replacing cumbersome manual MFA processes by enabling Patients and Guarantors to submit MFA applications and supporting documents entirely within a secured online environment which transmits to Hospital A’s Charity Care administration management solution, in real-time, enabling Hospital A to initiate application review processes immediately.  The solution must be secure, scalable and configurable to meet Hospital A’s specific needs.

The following features were identified, which served as guiding principles for the development of what is today Caritas360:

  • Provide patients direct access, across multiple access points, to Hospital A’s Charity Care application within two clicks via Hospital A’s online Patient Portal;
  • Assist Hospital A mitigate HIPAA violation risk while helping patients;
  • Assist Hospital A with compliance to 501(r) and other federal and state regulations to maintain their tax-exempt status;
  • Direct low-income patients to financial assistance navigators early in the revenue cycle process;
  • Facilitate access to financial assistance navigators for terminally ill and catastrophic injury patients;
  • Streamline MFA eligibility processes and provide business intelligence to support credible and defensible decisions relative to FAP application and avoid pursuit of extraordinary collection actions (ECAs);
  • Provide direct access to meaningful data points relative to MFA adjudication process, eligibility disposition, and data outputs to facilitate and assist with compliance reporting, (i.e. IRS Form 990 Schedule H / Line 7a. data elements)
Caritas360 in action on a desktop computer to improve patient satisfaction and reduce staff processing time

Results

Caritas360 was developed as a singular platform with two distinct and fully-integrated components; eMFA and vCCA.

On the one hand, eMFA (electronic Medical Financial Assistance) is a user friendly web-based MFA application submission platform that allows Patients to easily apply for and submit their MFA application to the Hospital A electronically.

Features include:

  • Two-factor authentication access control for returning to eMFA;
  • ‘Save and Return’ capabilities for patient to save work and complete form at a later date;
  • 100% OS and browser agnostic, PC and mobile devices compatibility;
  • Applicant will have the ability to upload documents in support of application, in real-time;
  • Intuitive and user friendly form-completion flow with easy to understand instructions;
  • eMFA will accommodate a many-to-one submission, enabling a guarantor applicant to submit for MFA on up to ten  individual patient medical bills in a single application.

The second component, vCCA (virtual Charity Care Administration) is a secured cloud-based application that systematically receives all eMFA’s and allows for the manual entry of MFA applications taken by the PFA team over the phone or those received by mail.

Features include:

  • Two-factor authentication access to vCCA for maximum ePHI security and confidentiality protection;
  • Role-based access and restricted usage;
  • Session time-outs;
  • Seamless integration between eMFA and vCCA;
  • Verification-based integrated workflow;
  • Intuitive, web-based interface;
  • Flexible and robust reporting, including batch files to provide documentation support to assist with 990 Schedule H tax filing;
  • Streamlined charity care eligibility determinative processing improving 501(r)(4) compliance;
  • Dynamic dashboards with real-time “in queue” statistics and adjudication metrics;

Within 180 days from full implementation, Hospital A realized the following tangible and quantifiable Results:

  1. Average MFA application backlog pending adjudication dropped by 50% from 3,000 to under 1,500;
  2. Average MFA application processing time dropped from 30 minutes to under 18 minutes, improving operational efficiency by a margin of 40%;
  3. PFA Charity Care Team staff reduced by margin of 43%, FTE count went from (7) dedicated PFA rep’s to (4);
  4. Number of “hard-copy” MFA applications retained reduced by 100%, with all applications received either via eMFA or having been entered into vCCA portal by PFA Representatives;

Benefits of Caritas360 Include:

Get started today with Caritas360

Save Money. Enhance Patient Experience. Improve Work Flow Efficiency. Eliminate Paperwork. Increase 501(r) Compliance.

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