| On-site screening services |
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HSI provides Eligibility Specialist(s) to conduct on-site screening of self-pay patients to determine the potential reimbursement from a Federal/Local program. We conduct these services as a community outreach program, assisting patients through the eligibility process. Our main payors consist of Medicaid, Supplemental Security Income (SSI), County Indigent and Victims of Crime. Additionally, we provide lien services for those patient accounts whereby there is a third party liable for their injuries.
Our focus is the following
- Maintain above industry-standard percentage of claims turned to reimbursable programs
- Provide customized reports so requested by our clients
- Dedicate knowledgeable staff and management to each program
- Reconcile all accounts on a monthly basis
- Offer competitive fees
- Become part of our clients' “team”
To accomplish these tasks, we provide the following:
- Morning and afternoon review of daily inpatient/outpatient/ER self-pay census for potential interviews
- Visit patients/family at bedside to determine eligibility
- Hand out charity applications to those patients who are not eligible for funding programs, as requested by facility
- Establish DHS interviews for eligible patients
- Assist patients to interviews, providing transportation as necessary
- Provide patient with required documentation prior to interview
- Have positive/negative determinations within forty five (45) days of referral
- Provide detailed documentation of all work events to our clients' patient accounting systems
- Follow up with client Billing Department to verify successful conclusion/payment
- Change patient accounting financial classifications as necessary
The Medicaid program provides medical assistance for certain individuals and families with low incomes and resources. Medicaid eligibility is limited to individuals who fall into specific categories.
Medicaid is a state-administered program, and each state sets its own guidelines regarding eligibility and services.
To assist in this program, HSI provides the following:
- Contact patient to obtain all applicable information
- Complete the application process
- Submit application to DHS
- Follow up with DHS
- Follow up with client Billing Department
- Out of state Medicaid Billing
HSI aggressively utilizes the numerous contacts developed over the years with Social Security, Administrative Law judges and medical professionals to expedite SSI claims to a positive conclusion. It is a truly "team approach" to success.
To assist in this program, HSI provides the following:
- Quickly establish trust with patient and family
- Hospital bedside or home interviews
- Assistance with applications and other paperwork
- Transportation to SSA office if needed
- Evaluation of medical evidence to determine if inability to do any work for 12 months exists
- Continual interaction with SSA by attending seminars thoughout the state and use of the SSA internet web site (member of SSA electronic news update)
- Use of elaborate systems of contacts with the SSA, Disability Determination Services and the Office of Hearings and Appeals
- Follow-up with appeals system
- Knowledge of Code of Federal Regulations to cite examples of court law to strengthen a claim
HSI will research availability of County Indigent Health Care Program (CIHCP) to assure that the provider is reimbursed for services rendered.To accomplish these tasks, we provide the following:
- Contact patient to obtain appropriate information
- Assist with application process
- Follow-up with County
- Follow-up with appeals process
Our process for filing and follow-up of liens results in a win-win situation. Except where adjusted or reduced under legal circumstances, hospital charges are 100% reimbursible.
The HSI Specialist will refer potential lien accounts to the Corporate office, where our dedicated Lien Department will begin working the accounts. Account updates are either entered directly to the client's patient accounting system from HSI Corporate, through remote access, or by the on-site Specialist via faxed/emailed reports from Corporate.
- Review daily census for potential lien cases
- Contact patient/libel party for accident information
- Request police report when necessary
- Perform Lien at local County Clerk's office
- Contact patient/attorneys/insurance adjusters immediately
- Mail the lien to patient/attorney/insurance adjuster, as requested
- Contact client to discuss any request for a reduction
- Release liens as appropriate
Often overlooked in recovering hospital charges is the Crime Victims' Compensation Program (CVCP) which may provide financial assistance to victims of violent crime for related expenses not reimbursible from other sources.
This program is administered by the Office of the Attorney General, which determines qualification of victims under the statutory guidelines of the Texas Crime Victims' Compensation Act and the procedures under 1 Texas Administrative Code, Part III, chapter 61.
The victim, dependents and immediate family members of the victim, and/or persons having legal/financial responsibility for covered expenses may be eligible for aid from CVCP.
To assist in this program, HSI provides the following:
- Complete the application process
- Submit application to Attorney General's office
- Follow-up with Attorney General's office
- Process account for billing
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