Paul is the Corporate Director of Admissions for a regional health care system. He knows his way around admissions, starting out in the industry almost a decade ago as a coordinator, and has seen the pace of change increase exponentially. While this can be a thankless job, Paul finds satisfaction in soldiering through the grueling patient access environment with his team. It is a new battlefield every day, dictated by the real-time reporting and data-focused nature of the industry. In reality, the numbers do mean a lot. Paul is always looking at how his team can solve current hotspots and better prevent or prepare for such issues in the future.
This constant responsiveness is swelling with rapid industry advancement. The changing role of payors, mergers and acquisitions, the constant uncertainty in regulatory oversight…maintaining consistently high accuracy while also being flexible enough to address these industry changes is a critical balance. Paul knows if you don’t stay in front of it, it costs you in the end.
A recent acquisition brought the source of these changes close to home for Paul. His hospital acquired a facility positioned near the border. Although the acquisition represented an exciting growth opportunity for the healthcare system and Paul’s team, it carried with it a unique challenge within patient eligibility. Soon after the acquisition, it was discovered that 65% of claims were being denied based on falsified Medicare cards. This was definitely a new one for Paul. He needed a trustworthy partner and solution get out in front of this alarming denial trend.
Paul turned to Pelitas to defend his bottom line by preventing these denials. With a comprehensive and veraciously precise patient profile database, Pelitas allows Paul’s team to flag potential problems accurately in the pre-screen, saving them from the after-care war with Medicare. “When we verify through Pelitas, we are correctly notified of patient status flags, in ways other systems have missed.”
Paul uses this to arm his partner facilities by helping them understand the risk they would take in accepting potentially problematic profiles. Essentially training his CEOs, Paul is able to show the story of referral eligibility risk in a tangible, data based report. His team avoided over $1M in lost revenue due to the alerts and verifications from the Pelitas platform.
“The CEOs and partners are grateful. This showed them the info we were getting was accurate and a portion of their referrals were actually costing us in the long run.”