In school, we are told to get above a C. But in healthcare, Cs are good things! Below, we will discuss the four characteristics that set DECO apart from other organizations: Capture Rate, Coverage, Cycle Times and Communication.
Capture Rates for an Eligibility partner/vendor should be one of the key indicators of success for hospitals. We have found that our success rate in ensuring patients are qualified for Medicaid/Disability/SSI goes up if we are able to capture the patient and complete the applications while the patient is still in-house. Our expected minimum capture rate for all applications is 94%. This capture rate is especially important in states that have eliminated retroactive coverage.
Coverage for both inpatient and Emergency Department/outpatient referrals is also important. This includes in-house representatives for both the inpatient and the Emergency Department for peak times. These representatives work seven days a week, ensuring that no patient is discharged before being interviewed by DECO. Our staff takes great pride in making sure all applications and documents have been secured while the patient is still in-house. This leads to more patients being certified.
Cycle Times should be measured by every Eligibility partner vendor and hospital as to the following:
- Date of Admission to Referral
- Date of Referral to Completion of Application
- Completion of Application to Submission
- Completion to Certification
These cycle times allow us to measure how quickly the Eligibility Certification process takes. The faster this process goes, the faster the hospital gets the Medicaid number to bill the claim and get paid. The goal of every Eligibility partner is to make this process as efficient as possible.
Communication with each department of the hospital is by far the most important part of the process. Communication between our team, case management, social workers, financial counselors, registration and more is crucial to having a successful team. Unclear or unhelpful communication with an Eligibility partner can lead to mistakes or lost revenue.
DECO uses these four concepts together to provide the highest level of Eligibility service. For the organizations we partner with, this means more patients are captured and processed, leading to less lost revenue. If you’d like to learn more about DECO and our services, let us know.