Q&A with Kristi Heverling, PatientMatters Operations Manager
Kristi Heverling is an Operations Manager who serves the underinsured and uninsured patient populations of PatientMatters’ client hospitals and health systems. With over 16 years of public benefit expertise, Kristi plays a key role in the end-to-end management of patient eligibility and enrollment services – including connecting patients requiring financial assistance to a broad range of federal, state, and local medical benefits including Medicaid, Social Security, and Disability. Her extensive knowledge and compassion elevate the patient experience for all she supports. Kristi holds a Master of Public Administration from Arkansas State University and is a member of the HFMA Arkansas chapter.
Q: What is Financial Advocacy in healthcare?
A: Advocacy is often described as “tackling an issue for someone else” and that is exactly the role of a Financial Advocate in healthcare. As a means of safeguarding good patient care, an Advocate is tasked with helping the patient navigate the arduous process of applying for state or federal financial medical benefits assistance.
The Advocate addresses the financial needs of an individual patient and educates and assists patients and/or families to access financial resources through state, county, and federal programs. The task of navigating the ins and outs of the financial aspects of care can be very daunting for patients, especially when a patient is ill. Providing information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and compassion is key to the role of an Advocate.
Public Benefits Advocates are experts at navigating the maze of paperwork and patient follow-through. An Advocate fosters positive patient relationships by initiating problem-solving and conflict resolution to benefit both the patient and the healthcare provider. Advocates maintain professional relationships and communicate relevant information to other members of the healthcare team both within the facility and with applicable agencies.
By identifying and connecting patients to public benefits, Advocates play an integral role in enhancing the patient's financial experience as well as improving the hospital’s bottom line by capturing revenue that would otherwise be lost.
Q: How does Financial Advocacy help address today’s financial challenges?
A: The COVID-19 pandemic has continued to present hospital and health system leaders with critical operational and financial challenges. Although operational margins have been a challenge for years, the American Hospital Association (AHA) estimates during the first 4 months of the pandemic U.S. hospitals will suffer a loss of $200 billion. The financial challenges brought about by the pandemic coupled with the ever-changing impact of policy, protocol, and law that affects public benefit categories and reimbursement rates have magnified the financial strains on hospitals.
By including state and federal Advocates with specialized knowledge and up-to-date information, hospitals can help to lessen the financial burdens felt today. Patient Advocacy can enhance revenue cycle management (RCM) by helping to fill hospital revenue and staffing gaps. With Advocacy partners, such as PatientMatters, hospitals incur no upfront or fixed costs. The cost for Advocacy eligibility and enrollment services is incurred only when a patient is qualified for a public benefits program and the hospital is reimbursed.
Advocacy offers hospitals the opportunity to not only recover earned revenue but also meet the needs of their underinsured or uninsured patients. Patients can focus on healing without the added worries over financial stress and providers have the added benefit of maximizing revenue.
Q: Why is Advocacy an important part of a Patient-centric Financial Approach?
A: Patients want to feel like they are more than a name on a screen or an outstanding bill. Advocacy is one way to bridge the gap and remove the financial barrier for patients and providers alike. Having an Advocate who is in touch with the patient and the patient’s individual circumstances assures them their well-being is a priority while also confirming to the provider that increasing reimbursement is paramount. The result of being patient-centered and partner-focused is that the needs of all involved are met.
PatientMatters’ Director, On-site Partnership, Matt Simon explains, "as a result of the Price Transparency mandate, hospitals are now required to move the patient financial conversation from the back end of the Revenue Cycle to the front end." By implementing Advocacy into your RCM strategy, you will foster patient engagement from the beginning of the patient’s care journey. Advocacy enables providers to address patient financial needs upfront which can be the biggest hurdle to overcome in fostering patient-centered engagement.
Advocacy is comparable to putting your organization in a patient’s shoes. Advocates spend the time getting to know each patient’s needs and walk them through all eligibility and enrollment processes to ensure financial assistance success at the end. It’s all about focusing on the individual financial situation of each patient and connecting them with the government programs that fit their circumstance.
Q: What are the challenges when implementing Financial Advocacy?
A: A high level of engagement and coordination of all teams is crucial to a successful rollout and consistency is key when introducing Advocacy into a healthcare organization. Continuous coordination between various hospital teams such as Front-end: Patient Access and/or Registration; Middle: Case Management and/or Financial Counselors; and Back-end: Billing is critical. Additionally, it is imperative that your hospital IT team has the capacity and availability to support the implementation initiative.
If hospitals are to implement Advocacy on its own or in conjunction with a partner, there are several strategies that can help to mitigate potential challenges:
- Transparency - Develop comprehensive written procedures outlining the processes, procedures, and accountabilities for patient eligibility and enrollment programs.
- Consistency - Define roles and responsibilities to ensure the patient screening, interviews, and education provided are optimized through consistent processes and procedures.
- Tools - Utilize technology to accurately capture patient eligibility information throughout the registration and admission process and to help identify and connect eligible patients to public benefits sources.
- Staffing, Training, Ongoing Education, and Performance - Be mindful of the programs necessary to deploy effective Advocacy services such as required staff qualifications including the socio-demographic characteristics of the hospital's patient community, expanded work hours, and training & performance monitoring. Hospitals should coordinate its Advocacy efforts with all appropriate patient touchpoints including clinical, administrative, and operational staff.
- Staff-Patient Communication - Implement training programs to instruct staff on how to provide a dignified financial experience for the patient. This includes how to ask the right questions about a patient’s situation and appropriate responses to potential questions. Staff-patient communication should create trust and engage the patient in a conversation. Conversations should be comfortable for the patient as they discuss what may be considered sensitive information. Time should be spent on educating the patient using both written and verbal communication.
Q: What should you look for in a Financial Advocacy partner?
A: Partners that offer specialized Advocates that deal in their particular area of expertise be it state or federal, are fundamental to a successful Patient Advocacy initiative. Ideally, Advocacy partners maintain current information on criteria and explore all options for reimbursement unique to each patient, while also assisting the provider with processes that will increase reimbursements and reduce bad debt.
Most importantly, hospitals should engage with partners that operate with high ethical standards – partners that mirror the hospital’s mission and culture. When an Advocacy partner represents your facility, their employees do the same.
Here's what one of our Financial Advocacy client partners said about us:
“PatientMatters eligibility program provided returns that exceeded our most aggressive estimates. Our hospital made many friends for life by connecting patients with a form of ongoing insurance coverage.”
CFO, MISSOURI DELTA
Want to learn more?
When hospitals provide patients a financial experience they can trust and the options they need, everyone wins. Learn more about IntelliGuide™ Advocacy solutions, here.
