Helping Financial Advocates Track Patient Assistance & Preauthorizations

The interactive and virtual ACCC Financial Advocacy Network Town Hall: Tips for Tracking Impact, held March 23, 2021, featured financial navigation experts sharing tips and tools to address patient financial need. Accessible now on demand, the meeting’s sessions include a panel discussion moderated by Financial Advocacy Network Chair Lori Schneider that addressed participants’ questions on why you should begin tracking financial assistance and prior authorizations and how best to do it.  

Francinna Scott-Jones, a financial coordinator at Northside Hospital in Atlanta, Ga., shared with town hall attendees about ways to connect through the ACCC Financial Advocacy Network. Coffee Chats allow members to connect in informal settings and talk about topics that affect financial advocacy teams on a day-to-day basis. The next Coffee Chat, scheduled for May 4, 2021, will focus on the various roles and responsibilities of financial advocates. (Registration is required and limited.)  

During her session, Jordan Karwedsky, financial counselor at Green Bay Oncology in Green Bay, Wis., talked to participants about why and how to track the savings achieved for your patients and your practice. Sharing the full picture of the dollars you’ve saved can go far in demonstrating the value of financial advocacy. Tracking this savings provides several benefits, including: 
 

Christina Fuller, an oncology patient financial navigator at Mosaic Life Care Cancer Care in St. Joseph, Mo., then shared a process improvement case study for tracking prior authorizations. During monthly meetings, the Mosaic team had noticed an increase in first-pass prior authorization denials and identified an issue related to communication between the different EMR systems used in the clinic and the hospital billing system. Learning how to implement a Plan-Do-Check-Act process improvement framework helped Fuller’s team restructure thier navigators’ responsibilities and track the time spent on completing data entries into both EMRs. 

Q&A 

Closing out the town hall, participants received answers to questions from the day’s presenters: 

Is there one resource available to access all the various policy changes of different insurance companies? 

Scott-Jones: I track the dates that policies will be up for review and put those dates on my calendar. Then I have pop-ups to remind me to look for the new policy and replace the old one in a shared drive that everyone can access.  

Karwedsky: I get daily email alerts through a fee-based service for insurance policy changes. It’s a good one-stop shop for seeing insurance policy changes. We rotate who on the team monitors these on a weekly basis, and then the person who is monitoring will send relevant updates out to the rest of team. 

Fuller: I follow the companies’ quarterly emails with policy information. If there is pertinent information, I’ll pass it on to everyone, including clinic managers who can pass it along to physicians.  

How do you ensure payer plan codes for foundations that you’ve put in the system are not added as secondary payers by outside services or otherwise put on a claim incorrectly? 

Karwedsky: We have a contact in the hospital’s billing department who contacts foundations and co-pay card programs directly for payment. She ensures that only the things the foundation pays for are going out on those claims for those programs. When the patients are preregistered for their appointments, you can see what they are coming in for: office visit, labs, or appointments. If the patient is coming in for an office visit, then the co-pay card isn’t attached to their account, but if they are coming in for treatment, it gets attached. That way it’s there to be billed when insurance pays.  

When authorizing chemotherapy and once approved, how do you verify benefits on a regular basis?  

Fuller: We use a system at check-in so that if a patient has a change in insurance, the financial navigator will check with the physician to see how long the insurance company will take to manage eligibility for benefits.  

Karwedsky: Our patients’ insurance is verified on a monthly basis. Our work is done using a work queue, so when patients’ insurance changes, it automatically is put in the queue to be addressed.  

Scott-Jones: We verify benefits initially. For radiation, it’s a little bit different since patients visit daily for up to six weeks. We use a system to check eligibility when the patient checks in. If something changes or there is a change in insurance, the intake team is notified to follow up and obtain authorization if needed.  

Are there any benchmarking metrics to support the number of financial navigators needed for a cancer program or practice? 

Scott-Jones: I’ve asked my staff to provide a daily report via a spreadsheet on services provided to each patient. As a team, we defined the time on average each task should take, and on a weekly basis, I look at the times spent on tasks to see if bandwidth is there or if another financial navigator needs to be added to the team. We really try to drill down and get a good number. We are able to quantify by time and task and how many FTEs we have and what bandwidth exists for us to push other duties to someone when needed.  

Do you have a good way to track insurance optimization? 

Karwedsky: When we are helping patients with Medicare low-income subsidy for part D, we just have a simple spreadsheet to track who the patient is, when we submitted the application, and what the status of the application is. In this case, you are tracking how many people you are helping to get better coverage, but you could also look at how much money they are saving.  

Fuller: Excel is a great tool even though it’s all manual. You can tailor it with the information you need.  

What advice would you give to a small program in the infancy stage of building a financial navigation program? 

Fuller: Track your patients. That will help with showing the needs of your patients and the need for financial navigators. When I started doing this, I started tracking just co-pays and foundations for a year. Then I added in tracking of free drug programs [patient assistance programs]. This helps show your return on investment and where you are needed. That’s the most important thing. Plus, if you track the amount of time you are spending on prior authorizations, that shows need as well.  

Karwedsky: Tracking is important. We didn’t start by tracking all the things we track today. Take baby steps. Find something to start tracking, and once you have a handle on it, find something else to add in and keep tracking that.  

Scott-Jones: Make sure you define what you are trying to accomplish in your program. Is it assisting the patients? Is it looking at the organization’s bottom line? There is a difference between a financial counselor and financial advocate, in my opinion. Counselors are trying to collect revenue and make sure they are helping the company with the revenue cycle and point of service collections. An advocate is truly trying to find resources for the patient. It might be the same person, but for a small organization it’s important to define these roles and build around that.  

If you missed this Town Hall meeting, register for the replay here.  

The spring update to the 2021 ACCC Patient Assistance & Reimbursement Guide is here!  

An essential tool for financial advocates, the ACCC Patient Assistance & Reimbursement Guide can help users easily find and access patient financial assistance resources. The update adds additional resources to help patients afford their prescribed oncology medications through manufacturer-based programs. The guide can be helpful to both financial advocates new to their role and experienced veterans in the field. The ACCC Patient Assistance & Reimbursement Guide is updated every quarter to give financial advocates the timeliest information available to help their patients afford their care.