We’ve spoken to hundreds of FQHC enrollment departments over the years, all of which are required to give some type of productivity report to their manager or executive team. What we’ve learned is most of these reports do not contain the single most important data point needed for an executive team to measure success of the department:
% of uninsured patients who qualify for reimbursable coverage
This single metric identifies the exact revenue opportunity to be paid for services provided. Without this number, how can any executive measure the number of dollars at risk with each uninsured visit?
Yes, you can measure the number of uninsured visits. Yes, you can measure the number of applications you’ve submitted. But most FQHCs do not understand how many patients actually qualify and never even start the enrollment process. Understanding this data point will help you identify the revenue opportunity in your organization.
Scenario One: Small FQHC in an expanded state serving 4,500 patients.
- This clinic has had one enrollment counselor for years. After three months of using PointCare, she screened 147 uninsured patients, 73% or 128 of which actually qualified for Medicaid. The opportunity for reimbursement is simple: Number of qualified patients x the PPS rate, or in this case $19,200. This one enrollment counselor started applications on a majority of these patients but couldn’t keep up with the volume. So the question needs to be asked: Should the FQHC hire another enrollment counselor to help capture the revenue opportunity? Now that they have the data, the answer is pretty clear. Without the data, they would continue to be content with one enrollment counselor while allowing the unseen revenue walk out the door day after day.
Scenario Two: Large FQHC in non-expanded state serving 60,000 patients
- This clinic has many enrollment counselors and has done a fairly good job keeping track of Medicaid applications submitted and approved. Prior to PointCare they submitted 1,985 applications in a 3 month period and figured they all qualified. After using PointCare for 3 months, they discovered that a majority of the patients they took applications on didn’t actually qualify for Medicaid resulting in wasted time and denied applications. Because they were taking applications on anyone willing to get enrolled they missed opportunities to enroll just the patients that did qualify and would ultimately result in an approval. After using PointCare, they reduced the number of applications by nearly 50% and increased approvals by 3x. Here is the before and after.
These two case studies showcase how proper qualification processes and data allow executives to make better decisions surrounding their enrollment teams.
To get started, this can be done in 3 steps:
- Screen all your uninsured patients using PointCare Qualify
- Identify the Revenue Opportunity (Qualified patients x PPS rate)
- Allocate resources appropriately to capture this opportunity
Contact us if you are interested in learning more about how we can help you implement these best practices and start truly measuring the success of your enrollment team.
Recommended: View our previous blog post "The number of uninsured patients that actually qualify for Medicaid will surprise you."